Early Childhood Referral to Early Childhood Partners

Please use the form below, or download the attached form, to record information about a child aged under 6 years old with developmental delay or concerns and under 9 years with a diagnosed disability who is seeking support through the National Disability Insurance Scheme (NDIS).

Who can benefit from EC?

A child aged 0-8 who has either:

  • developmental delay, including developmental concerns (under 6 years old) or
  • a disability (under 9 years old); and
  • lives in the Riverina-Murray region of NSW and Loddon, Goulburn and Mallee regions of Victoria.

The Early Childhood Partner’s role

  • The first contact point for families and carers of children aged under nine years seeking support through the NDIS.
  • To determine with families or carers the most appropriate supports that would benefit and achieve outcomes for your child, tailored to their individual needs and circumstances.

The types of supports provided by an Early Childhood Partner may include:

  • Information
  • Support to connect to mainstream and community services;
  • Early Supports (Short-term early intervention); or
  • Where required, assistance to request access to the NDIS.

How to complete and submit this form

This form may be completed by:

  • family or carers
  • a professional working with the family or carer such as a GP, Paediatrician or Childcare Educator

There are three steps to complete and lodge this form:

  1. Complete the EC referral to Early Childhood Partner form below or download and print the attached form.
  2. Record parent, carer, guardian or child representative consent.
  3. If consent is provided by the parent, carer or guardian, please attach copies of any relevant assessments, reports or letters from health professionals that describe the child’s needs in support of this information form where appropriate.

Complete form

You can save a partially completed form to continue at a later date if required.

Using the downloadable form

If using the downloadable form, please return the completed information form and any attachments to:

  • Email: Intereach-EarlyChildhood@ndis.gov.au
  • Mail: PO Box 501, Deniliquin NSW 2710
  • In person: Intereach offices are located in Albury, Balranald, Bendigo, Cootamundra, Corowa, Deniliquin, Echuca, Finley, Gisborne, Griffith, Hay, Maryborough, Mildura, Seymour, Shepparton, Swan Hill and Wagga Wagga.

Download form