Please complete the pre-application below. This application may take up to 20 minutes to complete. The information collected will be used solely for the purpose of enrollment. If you need assistance, please call 717-263-8019 during our normal business hours, Monday - Friday, 8:30 am - 4:00 pm.
Parent/Guardian
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Email Address (Required)
Confirm Email Address
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
American Sign Language
Arabic
Chinese
Creole
English
French
Italian
Korean
Mam
Mixteco
Nepali
Other
Portugese
Russian
Sign Language
Spanish
Tai
Urdu
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Medicaid
No Insurance
Other
Private Health Insurance
Doctor/Medical Home
2-1-1
ABC Pediatrics
Abraxas Youth Center
Adult Inpatient Substance Abuse
Advanced Pediatric Dental
Adventist Health Community Care
Affordable Care Act
American Cancer Society FC Unit
Antietam Pediatric
Antrim Family Med
Bedford Dental Health Center
Bedford Pediatrics
Benjamin N. Fogel
Birth Matters - Doula Kara Piper
Broadway Pediatrics MDPC
Brook Lane Health Services
Brook Lane Health Services
CADD-WellSpan PhilHaven
Carlisle Pediatric Associates
Carrol Children's Center
Carroll Children's Center
Carroll Health Group Primary
Central Presby. Church of CHBG
Chambersburg Apothecary
Chambersburg Hospital
Chambersburg Hospital Therapy
Chambersburg Urgent Care
Chesapeake Health Care Pediatric
Chesapeake Pediatric Dental
Children of Joy Pediatrics
Children's Community Pediatrics
Children's National Anacostia
Children's Pediatrics & Assoc.
Children's Primary Care Medical
Childrens Hospital Of Pittsburgh
CHOP Primary Care
Chron's & Colotis Support Group
Clinc For Children
CPO2 Medical Equip & Supplies
Crystal Run Healthcare, LLP
Cumberland Valley Breast Care
Cumberland Valley Family
Dental Health of Silver Springs
Dick's Homecare
Dr Dan Glaser
Dr Joel McGahen OD
Dr Paul Mauriello
Dr Schoedeil
Dr Toni Lyn Salvatore
Dr Wellmon
Dr. Allen B Ettenger
Dr. Christianne Schoedel
Dr. Christopher P. Severs
Dr. Chukwuemeka Obidi
Dr. Jacqueline Fogal, DDS
Dr. Leiberman Pediatrics
Dr. M. Azim Qureshi
Dr. Michael F. Grossberg
Dr. Paul Orange MD
Dr. Schodel - Ped Eye
Dr. Syed Hassan
Eastern Shore Pediatrics
Evangelical Community Hospital
Fairfield Family Medicine
Falling Spring Nursing & Rehab
Family First
Family First Health
Family First Health
Family First Health - GTBG
Family Health Care of Hagerstown
FCMC - Cardiology
First Choice Pedicatrics
First Start Partnerships
Flip Flops & Lollipops Pediatric
Forti & Consevage, PC
Francis Leiter Center
Franklin Co. Dept. of Health
Franklin County Head Start
Frederick Pediatric Associates
Frederick Primary Care Assoc.
Fulton County Med. Center Prog.
Fulton County Medical Center
Fulton County Medical Center
Fulton Family Practice
Geisinger Lewistown
Gentle Medicine Associates
Georgia Department Of Health
Georgia Department Of Public Hea
Gettysburg Pediatrics
Graham Medical Clinic
Greencastle Family Practice
Hagerstown Pediatrics
Hagerstown Smiles Dental Care
Hamiton Health Care Harrisburg
Hanover Pediatrics
Harbour Island Pediatrics
Harpers Ferry Family Practice
Harrisburg Hospital-MRI Imaging
Head Back Support Group
Healthy Baby Line
Hershey Hematology
Hershey Pediatrics
Holy Spirit Pediatric Specialist
Hughes & Hughes Family Dentistry
Huntingdon Family Dentistry
Hyndman Medical
Jared Gracken
JC Blair
Jerome Kids Dental
Joan Paskert, CNP
Joel Cortes, DDS
John Hopkins - Hagerstown
Karena K Strain, OD
Keystone Audiology and Speech
Keystone Behavior Health
Keystone Cardiology
Keystone Community Health Servic
Keystone Dental Care
Keystone Family Medicine
Keystone Health (Family)
Keystone Health Birth Contol
Keystone Health Cardiology
Keystone Health Info. Mgt. Dept.
Keystone HIV Program
Keystone Internal Medicine
Keystone Pediatric Developmental
Keystone Pediatrics
Keystone Pediatrics - Waynesboro
Keystone Pharmacy
Keystone Urgent Care
Keystone Women's Care
Kidz Therapy Zone
Kirby Memorial Health Center
Kristie Engler, DDS
Landsdowne Park Pediatrics
Laurel Life
lBHMG Frederick
Lehigh Valley Respiratory Care
LIU 12/Dr. Lisa Zoladkiewicz
LIU Evaluation Team
Lovelight Pediatrics
Marcial Jimenez, MD
MD Physicians Care
MDW-WHASC- Lackland
MedExpress Chambersburg
Medical Practices of Antietam
MedTox Laboratories Inc.
Mended Little Hearts
Menocal Family Practice
Menocal Family Practice
Mercersburg Family Dentistry
Mercersburg Family Practice
Mercy Family Care Physicians
Meritus Family Practice Walnut
Meritus Medical Center
Meritus Pediatric & Adult Med
Meritus Pediatric North Hagersto
Michael S Richheimer
Momentum Services
Mont Alto Family
Morris Heights Health Center
My EyeDr
MyEyeDoctor (Wayne Ave)
Nadal Pediatrics
Narinder Singh MD
National Hispanic Health Helplin
Newport News Pediatrics
NJ Eye and Ear
Nurse Family Partnership(Pinnacl
Nurse-Family Partnership
NYU Langone Pediatric Associates
Oak Landing Pediatric Dentistry
Ombudsman Services
Opal Court Pediatrics
Outpatient Substance Abuse
Overeaters Anonymous CHBG
PA Dept of Health
PA Dept of Health
Park Avenue Pharmacy
Partners in Peds & Family Health
Ped Ctr Of Fredrick-Myersville
Ped Endocrinology & Diabetes
Pediatric Care Center
Pediatric Center of Frederick
Pediatric Comprehensive Care
Pediatric Dental Care
Pediatric Specialist of FC
Pediatric Specialist of Franklin
Pediatrics Northwest PS
PEMA
Penn State Allergy & Immunology
Penn State Health
Penn State Health - Mechbrg
Penn State Health Carlisle
Penn State Health Medical Center
Penn State Health Pediatrics
Penn State Hershey Hospital
Penn State Hershey Medical Group
Penn State Neuroscience Institut
Penn State Pediatric Neurology
Physical Therapy, etc
PL Physicians
Porter Dental
Post Abortion Recovery Program
Post Abortion Recovery Program
Post Abortion Recovery Program
Precious Smiles
Pregnancy Ministries - Chbg
Pregnancy Ministries - GRN
Pregnancy Ministries SHBG
Pregnancy Ministries WBO
Premier Allergist
Pristine Smiles
PS Hershey Pediatric Pulmonary
Pure Grace 101 Post Abortion
Quest Diagnostics- Horsham Lab
Quest Diagnostics-Lenexa
Quest Nichols Institute
Regional Migrant Child Develop
Rhonda Brake Shreiner Women's
Robinwood Family Medicine
Ryan Women & Children's Center
Sadler Health Center
Samone Nore, MD
Saxton Family Practice-UPMC
Sexually Trasmitted Diseases
Shenandoah Community Health
Shippenburg Family Practice
Shippensburg Civic Center
Shippensburg Medical Therapy
Shriners Hospital Outreach Clini
Simply For Kids
Simply Kidz
Smithsburg Family Medical Center
Soma Medical Center
Southside Pediatrics
St Petersburg Pediatrics
St. Christophers Ped. Pulmonary
St. Christophers Pediatric Assoc
Stroke Survivor Support Group
Summit Care Discount Program
Summit ENT & Hearing services
Summit Health Imaging Services
Summit Health Imaging Services
Summit Health Imaging Services
Summit Health Imaging Services
Summit Health Occ. Health Srvcs
Summit Health Physical Medicine
Summit Health Support Groups
Summit Health Support Groups
Summit Health Support Groups
Summit Health Surgeons Serv.
Summit Health Waynesboro
Summit Physcian Services
Summit Primary Care
Summit Primary Care -Bldg #2
Summit Primary Care CHBG
Summit Primary Care CHBG
Summit Primary Care GRN
Summit Primary Care MBG
Summit Primary Care Mont Alto
Summit Primary Care Wybo
Summit Primary Care-Shippensburg
Summit Urgent Care
Summit Urology Group - CHBG
Summit Womens Group
Summit Womens Group WBO
Sweetgrass Pediatrics
The Children's Clinic
The Children's Doctor
The Practice of Pediatrics
Thurmont Family Dentistry
Tri-State Comm Health Center
Triad Adult & Pediatric Medicine
University Pediatric Group
UPMC Children's Specialists-Nero
UPMC Pediatrics Shippensburg
UPMC Primary Care Chambersburg
UPMC Primary Care Phoenix Drive
Walter Advanced Dental Care
Walter Reed National Medical Ctr
Waynesboro Comm. Health Nurse
Waynesboro Diaper Bank
Waynesboro Family
Waynesboro Hospital
WBO Family Medical Assoc.
Well span family medicaine
Well Span Family Mont Alto
Well Span Mont Alto
Wellness Family Practice
WellSpan
WellSpan Dental
WellSpan ENT & Hearing Services
WellSpan Family Med-Littlestown
WellSpan Family Medicine
Wellspan Family Medicine
Wellspan family medicine
WellSpan Family Medicine
WellSpan Family Medicine
Wellspan Family Medicine
WellSpan Family Medicine
WellSpan Family Medicine
WellSpan Health
WellSpan Health
Wellspan Internal Medicine
Wellspan Lab Services
Wellspan Maternal-Fetal Medicine
Wellspan Maternal-Fetal Medicine
Wellspan Neurology
WellSpan OB/GYN
Wellspan Pediatric Medicine
WellSpan Pediatric Neurology
WellSpan Pediatric- East Market
Wellspan Summit Physician Servic
WellSpan Urgent Care
WellSpan Urgent Care Greencastle
WellSpan Urgent Care- Waynesboro
WellSpan Urology- Waynesboro
Welsh Mountain Health Centers
Westover Hills Pediatric
Williamsport Dental
Women, Infant and Children
WSH CP Quest Lab
WVU Medicine Pediatrics
Yealy Eye Care
York ENT Associates
Youth Advocate Program Inc.
Youth Care Peds of Central GA
Dentist/Dental Home
Adamson Family Dentistry
Advanced Pediatric Dental
Amir Rabiee, DDS - Surgeon
Antrim Dental Care
Apple Valley Dental
Aspen Dental - Hagerstown
Aspen Dental - Waynesboro
Aspen Dental- Chambersburg
Bedford Dental Health Center
Blue Ridge Dental Care
Britto's Children's Dentristy
Byrd Dental
Carlisle Pediatric Associates
Chambersburg Dental Assoc
Chambersburg Family Dentistry
Chesapeake Pediatric Dental
Chesapeake Pediatric Dental
Children's Dental Center of York
Children's Dental Health -Mchbg
Children's Dental Health-Hbg
Children's Dental Health-Lancstr
Children's Dental Health-York
Children's Dental Surgery
Clinc For Children
Cornerstone Family Dentistry
Covenant Family Dentistry
crestwood comprehensive dental
Cumberland Valley Dental Care
Dental Associates in Gettysburg
Dental Health of Silver Springs
Dental Solutions of Chambersburg
Dr Cerveris
Dr Denning, DDS
Dr Manish Lakkad
Dr Ray
Dr Walker
Dr. Alexander J. McKinley
Dr. Burton Tucker
Dr. Denning, DDS
Dr. Jack Steele, DMD
Dr. Jacqueline Fogal, DDS
Dr. Jaime Horne, DDS
Dr. James J. Rosen Jr.
Dr. Jay Blickenstaff, DDS
Dr. Jeffrey Pearlman, DDS
Dr. John Beall, DDS
Dr. John Palm
Dr. Karen E. Garrison DDS
Dr. Keshmiri
Dr. Melvin Barber
Dr. Michael Denning, DDS
Dr. Rachel Kendall
Dr. Richard J Frank, DDS
Dr. Robert Zimmerman, DDS
Dr. Waverly LeBard, DDS
Dr. Wennick
Elite Dental
Elite Dental
Family Based Dentistry
Family First Health - GTBG
Family Health Care of Hagerstown
First Choice Dental Care
Fountain Head Dentistry
Frederick Pediatric Dental Assoc
Frederick Pediatric Dentistry
Garrison Karen Evans DDS
Gateway Insurance dental Clinic
Gettysburg Dental Assoc
Greencastle Family Dental
Guilford Hills Dental Care
GW Thorne and Hollingshead
Hagerstown Family Dental
Hagerstown Smiles Dental Care
Healthy Smiles
Hearthside Family Dental
Hughes & Hughes Family Dentistry
Huntingdon Family Dentistry
James J. Rosen, DDS
jennifer Harglerod
Jerome Kids Dental
Joel Cortes, DDS
John Palm
Johnny Joseph DMD
Just Kids Dental
Kearns & Ashby
Keystone Dental Care
Keystone Dental Mont Alto
Keystone Family Medicine
Keystone Pediatric Dental
Kids Dental Clinic
Kool Smiles
Kristie Engler, DDS
Lancaster Clef Palate Clinic
Lancaster surgical center
Longmeadow Family Dental Care
Mechanicsburg Family Dental
Melvin Barber, DDS
Menocal Family Practice
Mercersburg Family Dentistry
Mercersburg Family Dentistry
Michael Denning, DDS
Mobile Dentist
Morgan County Universal
Muller Family Dentistry
Oak Landing Pediatric Dentistry
Oral Health Impact Project
PA Dental Association
Pediatric Dental Associates
Pediatric Dental Care
Pediatric Dental Ctr Frederick
Pediatric Detistry
Phoenix Dental
Pine Dentistry
Porter Dental
Potomac Dental Centre
Precious Smiles
Pristine Smiles
Rivercity Dental
RobinWood Dental
Sage Dental
Smile Design Centre
Smile Haus Pediatric Dentistry
Smithsburg Allegheny Dental
Somerset Dental Associates
Summit Care Discount Program
Summit Family Dental
Thurmont Family Dentistry
Triad Kids Dental
U of P School of Dental Medicine
Up Town Family Dentistry
Valley Dental Assoc
Victor N. Amarteifis
Walter Advanced Dental Care
Wayne Heights Dental
WellSpan Dental
Westover Hills Pediatric
Williamsport Dental
Wolter Advanced Dental Care
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
First Start Partnerships 2024-2025
First Start Partnerships 2023-2024
Location Preference
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2nd Location Preference
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3rd Location Preference
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Click a location on the map to see more info
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Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Thank you for considering partnering with First Start Partnerships to ensure your child arrives ready for kindergarten. Please click 'Submit" to finalize your pre-application. Non-discrimination Statement In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, religion, sex, gender identity (including gender expression), sexual orientation, disability, age, marital status, family/parental status, income derived from a public assistance program, political beliefs, or reprisal or retaliation for prior civil rights activity, in any program or activity conducted or funded by USDA (not all bases apply to all programs). Remedies and complaint filing deadlines vary by program or incident. Persons with disabilities who require alternative means of communication for program information (e.g., Braille, large print, audiotape, American Sign Language, etc.) should contact the responsible Agency or USDA's TARGET Center at (202) 720-2600 (voice and TTY) or contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program discrimination complaint, complete the USDA Program Discrimination Complaint Form, AD-3027, found online at How to File a Program Discrimination Complaint and at any USDA office or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: Mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410 Fax: (202) 690-7442 Email: program.intake@usda.gov. First Start Partnerships is an equal opportunity provider and employer.
Required information is missing, see above.