Virtual Infant and Early Childhood Mental Health Consultation (IECMHC) Interest Form

Thank you for your interest in Virtual Infant and Early Childhood Mental Health Consultation (IECMHC). Our services support the social and emotional well-being of young children by partnering with the adults who care for them.

Please complete this form to help us connect you with the support that best meets your needs.

Note: this program is currently open for Michigan residents ONLY.

About You
Age(s) of Children You Support *:
For example, the name of your childcare program.
Service Type
Which type of support are you interested in? *
Focus of Support (Social/Emotional Only)
What would you like help with? *
Availability
Preferred Days for Virtual Consultation *:
Preferred Times for Virtual Consultation *:
Other
Your name, email, and any other information you provide will only be used for responding to your questions. Any information you provide will never be sold, shared, or used for any other purposes.