Padre/Guardián
Primer nombre (Requerido)
Apellido (Requerido)
Fecha de nacimiento (Requerido)
Sexo
Femenino
Masculino
Correo electrónico (Requerido)
Confirme el correo electrónico
Aparece que ha sometido una aplicación anteriormente. Si desea aplicar otra vez, por favor contáctenos por teléfono o en persona.
Celular
Optar por mensajes de texto
Sí
No
Teléfono de la casa
Teléfono del trabajo
Ext.
Aparece que ha sometido una aplicación anteriormente. Si desea aplicar otra vez, por favor contáctenos por teléfono o en persona.
Nivel de Educación
Asociado
GED
Grado 9 o menos
Grados 10
Grados 11
Grados 12
Graduado de secundaria
Licenciatura
Maestría
Titulo universitario/entrenamiento
Universidad o formación avanzada
Estado de empleo
Desempleado
Empleado Por Temporada
Entrenamiento o Escuela
Medio Tiempo
Medio Tiempo & Entrenamiento
Retirado o Incapacitado
Todo el Tiempo
Todo el Tiempo & Entrenamiento
Relación con el niño(a)
Adoptivo
Biologico/Adoptado/Padrastro
Nieto
Otro
Otro pariente
Dirección
¿Está su familia sin hogar?
Sí
No
Dirección de residencia (Requerido)
2da línea de dirección
Ciudad (Requerido)
Estado (Requerido)
Código postal (Requerido)
Haz click aquí
para buscar un proveedor en su área.
Dirección Postal es igual que dirección de residencia
Dirección Postal
Línea 2 de la dirección
Ciudad
Estado
Código Postal
Padre/Guardián adicional
¿Hay otro padre/guardián en la familia?
Sí
No
Primer nombre (Requerido)
Segundo nombre
Apellido (Requerido)
Fecha de nacimiento (Requerido)
Sexo
Femenino
Masculino
Celular
Optar por mensajes de texto
Sí
No
Teléfono de la casa
Teléfono del trabajo
Ext.
Aparece que ha sometido una aplicación anteriormente. Si desea aplicar otra vez, por favor contáctenos por teléfono o en persona.
Nivel de Educación
Asociado
GED
Grado 9 o menos
Grados 10
Grados 11
Grados 12
Graduado de secundaria
Licenciatura
Maestría
Titulo universitario/entrenamiento
Universidad o formación avanzada
Estado de empleo
Desempleado
Empleado Por Temporada
Entrenamiento o Escuela
Medio Tiempo
Medio Tiempo & Entrenamiento
Retirado o Incapacitado
Todo el Tiempo
Todo el Tiempo & Entrenamiento
Relación con el niño(a)
Adoptivo
Biologico/Adoptado/Padrastro
Nieto
Otro
Otro pariente
Vive con la Familia
Sí
No
Provee Asistencia Económica
Sí
No
Información de Familia
Número de padres/guardianes
Familia biparental
Familia de un solo padre
Relación con los participantes
Abuelo(s)
Otro
Otro pariente(s) que no sean abuelos
Padre(s) (por ejemplo, biologicos, adoptivos, padrastos)
Padre(s) de crianza no incluyendo los parientes
Lenguaje principal en el hogar
Arabic
Chinese
Creole
French
Inglés
Italian
Korean
Lenguaje Gestual Americano
Mam
Mixteco
Nepali
Other
Portugese
Russian
Sign Language
Spanish
Tai
Urdu
Número en familia
Cantidad anual
¿Reciben TANF?
Sí
No
¿Reciben SSI?
Sí
No
¿Reciben WIC?
Sí
No
¿Reciben SNAP?
Sí
No
Hay al menos un padre/guardián quien es un miembro activo de las fuerzas armadas de los Estados Unidos?
Sí
No
Hay al menos un padre/guardián quien es un veterano de las fuerzas armadas de los Estados Unidos?
Sí
No
Niño(a) (Solicitante)
Primer nombre (Requerido)
Segundo nombre
Apellido (Requerido)
Sufijo
Nombre preferido
Fecha de nacimiento (Requerido)
Sexo
Femenino
Masculino
Raza
Asiático
Blanco
Isleño Pacífico
Multirracial
Nativo Americano
Negro
Otro
Sin Especificar
Hispano
Sí
No
Cobertura de Salud Primaria
Medicaid
Otro
Programa de Seguro de Salud Infantil (CHIP)
Seguro de Salud Privado
Sin seguro
Doctor/ Proveedor de atención médica primaria
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 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
Dentista/ Proveedor de atención dental primaria
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
¿Su niño(a) tiene discapacidad o tiene usted preocupaciones del desarrollo del niño(a)?
Sí
No
¿Hay algo más que nos quiera decir sobre su niño(a)?
Preferencias
¿Cuál programa está solicitando? (Requerido)
First Start Partnerships 2024-2025
First Start Partnerships 2023-2024
Preferencia de ubicación
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Primera preferencia de ubicación
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Segunda preferencia de ubicación
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Tercera preferencia de ubicación
<p></p>
- Su Dirección
- Ubicaciones disponibles
Haz click en el mapa para ver más información
Haz click aquí
para buscar un proveedor en su área.
Solicitantes Adicionales
Tiene(en) otro niño(a) adicional por lo cual quisiera entrar una aplicación para servicios
Agregar otro solicitante
Gracias por su interés en el programa de First Start Partnerships. Haga clic en "Enviar" para finalizar su presolicitud. Le contactaremos para hacer una cita de reclutamiento.
Información requerida falta, por favor revisa.