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C.E.F.S. Economic Opportunity Corporation

1805 South Banker Street

Effingham IL 62401

217.342.2193

Head Start Child Referral

The CEFS Head Start 0-5 Program only provides services to children and families in the following Illinois counties: Christian, Clay, Effingham, Fayette, Montgomery, Moultrie, and Shelby.

Referring agency and/or provider name

Name of Contact Person

Phone

By providing a telephone number and submitting this form, you are consenting to be contacted by SMS text message. Message & data rates may apply. You can reply STOP to opt out of further messaging.

Fax

Email

Child's Information

Child's name

Date of birth

Parent/Guardian Name

Parent/Guardian Phone

Address

Reason for referral

C.E.F.S. Economic Opportunity Corporation

1805 South Banker Street PO Box 928

Effingham IL 62401

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