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KidsFirst Services Request Form
A variety of free and low cost programs are available to qualifying individuals through KidsFirst. Please complete the form below and click submit at the bottom of this page. PLEASE NOTE: KidsFirst is temporarily pausing counseling referrals. Please refer to Counseling Program Talking Points and Placer Coummunity Mental Health Agencies for more information. A KidsFirst Services Request Form can still be completed for other services such as case management basic needs supports, parenting classes, Parents as Teachers, etc.

 
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If making a referral for someone other than yourself, please complete this section so that you may be contacted

REQUIRED, PLEASE COMPLETE:

Enter $$$ Amount

FOR MDIC/DA's OFFICE ONLY