Attention Therapists and Agencies

To Become a Preschool Special Education Related Services Only Provider for Children Ages Three to Five Years Old:

Individuals and agencies that would like to contract with the Nassau County Department of Health to provide services for Nassau County Preschool Special Education Students with a Disability can request a contract application by using the link below to download the Contract Request Data Sheet and the State Central Register Database Check for Child Abuse (SCR) form.  Nassau County will process the SCR on behalf of the applicant(s). 

Debarment Form

forward resume and copy of license or certification along with completed forms to:

Nassau County Department of Health

Office of Children with Special Needs

Uniondale, NY 11553-3683

516-227-8647

To Become a New York State Approved Preschool Special Education 4410 Evaluation Agency, 4410 Special Education Itinerant Teacher (SEIT) Agency, and/or 4410 Center based Program Provider for Children Ages Three to Five Years Old:
Agency providers of Preschool Special Education evaluation, SEIT services, and center based programs are approved by New York State Department of Education (NYSED) and contracted with the local municipalities.

 Use the NYSED link below to obtain information and an application to become a NYSED approved 4410 Provider:

http://www.p12.nysed.gov/specialed/applications/preschool-home.html

For further information, contact the Education Preschool Policy Unit at (518) 473-6108 or the SEQA Regional Office in your region:

Once the agency has obtained the NYSED 4410 approval, the agency can request a contract application to provide 4410 approved evaluations, SEIT, and/or center based programs by using the link below to download the Contract Request Data Sheet and the State Central Register Database Check for Child Abuse (SCR) form.  Nassau County will process the SCR on behalf of the applicant(s). 

Request for Taxpayer ID- 700 Form

Debarment Form

forward resume and copy of license or certification along with completed forms to:

Nassau County Department of Health

Office of Children with Special Needs

Preschool Special Education Program

60 Charles Lindbergh Blvd, Suite 100

Uniondale, NY 11553-3683

516-227-8647

For Agencies to become a Related Services and 4410 Provider:

Once the agency has obtained the NYSED 4410 approval, the agency can request a contract application to provide Related Services in addition to 4410 approved evaluations, SEIT, and/or center based programs by using the link below to download the Contract Request Data Sheet and the State Central Register Database Check for Child Abuse (SCR) form.  Nassau County will process the SCR on behalf of the applicant(s). 

Request for Taxpayer ID- 700 Form

Debarment Form

forward resume and copy of license or certification along with completed forms to:

Nassau County Department of Health

Office of Children with Special Needs

Preschool Special Education Program

60 Charles Lindbergh Blvd, Suite 100

Uniondale, NY 11553-3683

516-227-8647