SCAN - Preparing parents. Protecting Children.

Network & Comm. Partners Referral

Network & Comm. Partners Referral

If you have problems with this form, feel free to contact us at (800) 752-7116.
Adams and Wells are no longer served by SCAN. Referrals for these counties can be made by calling Children's Bureau at (765) 381-0210.
Family Demographics
Language spoken in home
Children Information
Additional Information
Family Information
Referrer Information
Agency Information