In response to COVID-19, Easterseals serving Chicagoland and Rockford has adjusted programming and rescheduled events. View details here.
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Community Referral Form

Partnering With Parents

Question - Required - Families qualify for services if they are residents of Oak Park or River Forest, pregnant or caregiving for a child under age 3-5 and meet one or more of the following eligibility criteria (please check all that you know apply):
Please make at least 1 selection from the choices below.

  Parent/Caregiver Information
















Date of Birth:




What's this?


  Secondary contact for family:




If client is pregnant:

Question - Not Required - Date of expected delivery:



Referral Source Information






  Who can we contact if we cannot reach you using the above contact information?


   Please leave this field empty
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