Family Referral Form

CPCD…giving children a head start is a free preschool program for El Paso County families who qualify. If your family, or a family you are working with, has children ages 0 to 5 and they are interested in preschool and family support programs, fill out the referral form and a CPCD outreach team member will contact the parent/guardian listed below to continue a discussion about our services. CPCD accepts applications year-round and also places children in classrooms year-round.

Once the form is submitted, the parent/guardian listed below will be contacted to review details and discuss eligibility and enrollment. If you have urgent questions, please email us at referral@cpcd.org or call 719-635-1536. Thank you!

Referring Agency/Name (If applicable):

Contact Email (If applicable):

Parent/Guardian Name:(Required)

First Last

Children's First Names and Ages:(Required)

Parent/Guardian Phone:(Required)

Parent/Guardian Email:(Required)

Parent Prefers to be Contacted by:(Required)

Email

Phone Call

Text Message

Family/Guardian Language:(Required)

School District (If known):