<p> Important Steps, Inc. Early Childhood Intervention Agency</p><p>JUSTIFICATION LETTER</p><p>Child’s Name: ______DOB: ______Child’s EI ID #: ______</p><p> Request for additional ______Evaluation</p><p>______I. CURRENT FUNCTIONING: (Outcomes worked on and met. Child’s response to services)</p><p>II. CONCERNS/REASON FOR REQUEST (Explain the request for change in frequency/duration or request for an additional evaluation. Use specific examples)</p><p>III. RATIONALE FOR REQUEST (Why does a child need evaluation? Include the statement if parent agree with recommendations)</p><p>Therapist’s Signature: ______Discipline Date</p>