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)
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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.
Lives with Family
Sí
No
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
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
Hindi
Inglés
Italian
Korean
Lenguaje Gestual Americano
Mam
Mixteco
Nepali
Other
Portugese
Punjabi
Russian
Sign Language
Spanish
Spanish
Tai
Ukranian
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 (Requerido)
Medicaid
Otro
Programa de Seguro de Salud Infantil (CHIP)
Seguro de Salud Privado
Sin seguro
Doctor/ Proveedor de atención médica primaria (Requerido)
2-1-1
ABC Pediatrics
Adamson Family Dentistry
Advanced Pediatric Dentistry
Advanced Pediatric Dentistry
Adventist Health Community Care
Allegany Dental Care- Smithsburg
Allergy & Asthma Center
Amir Rabiee, DDS-Dental Surgery
Antietam Pediatric
Antrim Dental Care
Apple Valley Dental
Aspen Dental - Hagerstown
Aspen Dental - Waynesboro
Aspen Dental- Chambersburg
Balhara Internal Medicine
Barquist Army Health Clinic
Bedford Dental Health Center
Bedford/Fulton Head Start
Benjamin N. Fogel
Birth Matters - Doula Kara Piper
Blue Ridge Dental Care
Britto's Children's Dentristy
Broadway Pediatrics MDPC
Brook Lane Health Services
Brook Lane Health Services
Byrd Dental
CADD-WellSpan PhilHaven
Carlisle Army Barricks
Carlisle Pediatric Associates
Carroll Children's Center
Carroll Health Group Primary
CCAP- Community Action Program
Cen-Clear Child Services
Central PA Asthma and Allergy
Central Presby. Church of CHBG
Chambersburg Apothecary
Chambersburg Dental Assoc
Chambersburg Hospital
Chesapeake Health Care Pediatric
Chesapeake Ped. Dental- Dundalk
Children of Joy Pediatrics
Children's Clinic- Newport
Children's Comm. Ped. Everett
Children's Dental Centre 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
Children's National Anacostia
Children's Pediatrics & Assoc.
Children's Primary Care- Euclid
Childrens Hospital Of Pittsburgh
CHOP Primary Care, Chestnut Hill
CHOP Primary Care, CHOP Campus
CityLife Health
CLB Belle Glade Primary
Clinic For Children PA
Connie Martin RN State Health
Cornerstone Dental Health
Covenant Family Dentistry
CPO2 Medical Equip & Supplies
Crestwood Comprehensive Dental
Crohn's & Colotis Foundation
Crystal Run Healthcare, LLP
Cumberland Valley Breast Care
Cumberland Valley Family
Dental Dreams
Dental Health of Silver Springs
Dental Solutions of Chambersburg
Dick's Homecare Inc
Dr. Manish Lakkad, DMD
Dr. Alexander J. McKinley
Dr. Allen B Ettenger, MD
Dr. Christianne Schoedel, MD
Dr. Christopher P. Severs, MD
Dr. Chukwuemeka Obidi
Dr. Dan G. Glaser, MD
Dr. Delva Gesner, MD
Dr. Jack Steele, DMD
Dr. Jacqueline Fogal, DDS
Dr. Jaime Horne, DDS
Dr. James J. Rosen Jr., DDS
Dr. Jared Glacken, OD
Dr. Jay Blickenstaff, DDS
Dr. Jeffrey Pearlman, DDS
Dr. Jennifer K. Hargleroad, DDS
Dr. Joel Cortes, DDS
Dr. Joel H. McGahen, OD
Dr. John Beall, DDS
Dr. John Palm, DDS
Dr. Johnny Joseph, DMD
Dr. Karena K Strain, OD
Dr. Kristie Engler, DDS
Dr. Laura Leiberman, Pediatrics
Dr. M. Azim Qureshi, MD
Dr. Marcial Jimenez, MD
Dr. Melvin Barber, DDS
Dr. Michael D. Cerveris, DMD
Dr. Michael F. Grossberg, MD
Dr. Michael R. Denning, DDS
Dr. Michael S Richheimer, MD
Dr. Narinder G. Singh, MD
Dr. Paul D. Orange, MD
Dr. Paul Mauriello, MD
Dr. Phillip Colaizzo, MD
Dr. Rachel Kendall, DMD
Dr. Reza Keshmiri, DDS
Dr. Robert Wennick Jr.
Dr. Robert Zimmerman, DDS
Dr. Samone Nore, MD
Dr. Syed S. Hassan, MD
Dr. Toni Lyn Salvatore, MD
Dr. Victor N. Amarteifis, DDS
Drayer Physical Therapy
Eastern Shore Pediatrics
Elite Dental- Darby
Evangelical Community Hospital
Falling Spring Nursing & Rehab
Family Birthing Services
Family First Health - GTBG
Family First Health- Hannah Penn
Family First Health- Lewisberry
Family First Health-Dental GTBG
Family Healthcare Of Hagerstown
Family Medicine Susquehana
Family-yes but NO Name Provided
FamilyCare Services
FCMC - Cardiology
FCMC Diabetes Educator
First Choice Dental Care
First Choice Pedicatrics
First Start Partnerships
Flip Flops & Lollipops Pediatric
Forti & Consevage, PC
Fountain Head Dentistry
Francis Leiter Center
Frankford Ave Dental Center
Franklin Co. Dept. of Health
Franklin Co. Ped. Specialist
Fredeick County Pediatrics
Frederick Ped. Assoc.- Frederick
Frederick Pediatric Dental Assoc
Frederick Pediatric Dentistry
Frederick Primary Care Assoc.
Fulton County Medical Center
Fulton Family Practice
Geisinger Lewistown- Pediatrics
Gentle Medicine Associates
Georgia Department Of Health
Georgia Dept. Of Public Health
Gettysburg Dental Associates
Gettysburg Pediatrics
Grace Women and Children
Graham Medical Clinic
Greencastle Family Dental
Greencastle Family Practice
Guilford Hills Dental Care
GW Thorne and Hollingshead
Hagerstown Family Dental
Hagerstown Pediatrics
Hagerstown Smiles Dental Care
Hamiton Health Center Harrisburg
Hanover Pediatric Associates
Hanover Pediatric Dentistry
Harbour Island Pediatrics
Harpers Ferry Family Practice
Harrisburg Hospital-MRI Imaging
Hasbro Pediatric Primary Care
Head/Back Support Group
Healthy Baby Line
Healthy Children Ped. Medicine
Healthy Smiles Comm. Oral Health
Hearthside Family Dental
Himelfarb Surgery Center
HNL Lab Medicine Headquarters
Holyoke Health Center
Hughes & Hughes Family Dentistry
Hunt Club Pediatrics
Huntingdon Family Dentistry
Hyndman Medical
JC Blair Memorial Hospital
JC Blair Pediatric Care Center
Jerome Kids Dental
Joan Paskert, CNP
Joey L. Lane Optometrist Inc.
John Hopkins - Hagerstown
Just Kids Dental- Gettysburg
Kearns & Ashby Pediatric Dentist
Keystone Audiology And Speech
Keystone Behavioral Health
Keystone Comm. Health Servic
Keystone Dental Care
Keystone Dental Mont Alto
Keystone Family Medicine
Keystone Family Planning
Keystone Health HIV Program
Keystone Health Info. Mgt. Dept.
Keystone Internal Medicine
Keystone Pediatric Dental
Keystone Pediatric Developmental
Keystone Pediatrics - Waynesboro
Keystone Pediatrics- CHBG
Keystone Pharmacy
Keystone Urgent Care
Keystone Women's Care
Kids Dental Clinic
Kids Eye Care of Maryland
Kidz Therapy Zone
Kimbrough Ambulatory Care Center
Kings Co. Primary Care Peds
Kirby Memorial Health Center
Kool Smiles
Kushnir Family Dental
Lancaster Clef Palate Clinic
Lancaster Co. Ped. Dentistry
Landsdowne Park Pediatrics
Laurel Life
lBHMG Frederick
Lehigh Valley Respiratory Care
LIU 12/Dr. Lisa Zoladkiewicz
LIU Evaluation Team Unit 12
Long Island Pediatric Center
Longmeadow Family Dental Care
Lovelight Pediatrics
MagicLand Pediatric Dental
Mary's Center
MD Physicians Care
MDW-WHASC- Lackland
MedExpress Chambersburg
Medical Practices of Antietam
MedTox Laboratories Inc.
Meliora Health Services
Mended Little Hearts
Menocal Family Practice
Mercersburg Family Dentistry
Mercersburg Family Practice
Mercy Medical Hospital
Mercy Personal Physicians
Meritus Family Med- Hagerstown
Meritus Family Med- Robinwood
Meritus Family Med- Willimsport
Meritus Medical Center
Meritus Medical Lab
Meritus Pediatric & Adult Med
Meritus Pediatric North Hagersto
Migrant Child Develop Program
Momentum Services
Mont Alto Family
Morrell Advanced Practice, LLC
Morris Heights Health Center
Muller Family Dental
MyEyeDr.- Gateway Ave
MyEyeDr.- Wayne Ave
Nadal Pediatrics
National Hispanic Health Helplin
Newport News Pediatrics
Nicole C Buzzi, DMD
NJ Eye and Ear
NOVA Dental
Nurse Family Partnership(Pinnacl
Nurse-Family Partnership
NYU Langone Pediatric Associates
Oak Landing Pediatric Dentistry
Opal Court Pediatrics
Oral Health Impact Project
Overeaters Anonymous CHBG
PA Dental Association
PA Department Of Health
PA Dept Of Health- Adams Co.
PA Dept Of Health- Franklin Co.
Park Avenue Pharmacy
Partners in Peds & Family Health
Ped Ctr Of Fredrick-Myersville
Ped Endocrinology & Diabetes
Ped. Specialists Of Franklin Co.
Pediatric Affiliates Hampton Rds
Pediatric Assoc. of Winchester
Pediatric Center of Frederick
Pediatric Comprehensive Care
Pediatric Dental- Port Matilda
Pediatric Detistry Of Bronx
Pediatrics Northwest PS-James
Pediatrics of Central Florida
PEMA
Penn Family Care
Penn Highlands Healthcare
Penn State Allergy & Immunology
Penn State Bone & Joint- Ped.
Penn State Health - Mechbrg
Penn State Health Pediatrics
Penn State Health- Carlisle
Penn State Hershey Med. Center
Penn State Medical- Camp Hill
Penn State Neuroscience Institut
Penn State Ped. Specialties
Penn State Pediatric Neurology
Penn State Pediatric Specialist
Penn State Pediatrics- Nyes Rd
Phoenix Dental Care LLC
Phoenix Physical Therapy
Pinnacle Family Siver Springs
PL Physicians
Porter Dental- Baltimore
Potomac Dental Centre
Precious Smiles- Carlisle
Pregnancy Ministries, Inc. - GRN
Pregnancy Ministries, Inc.- CHBG
Pregnancy Ministries, Inc.- SHBG
Pregnancy Ministries, Inc.- WBO
Pregnancy Resource Center
Premier Allergist- CHBG
Pristine Smiles Family Dentistry
Privia Medical Mid-Atlantic Lab
PS Hershey Pediatric Pulmonary
PS Pediatric Hematology-Ocology
Quest Diagnostics Nichols Insti.
Quest Diagnostics- Horsham Lab
Quest Diagnostics-Lenexa
Reading Children's Health Center
Rhond B. Shreiner Women's Center
Rivercity Dental- Williamsport
Robinwood Dental- Hagerstown
Roxbury Treatment Center
Roxbury- Outpatient
Ryan Women & Children's Center
Sadler Health Center
Sage Dental Of Buford
Saviers Memorial Health Center
Saxton Family Practice-UPMC
Service Access & Management Inc.
Shenandoah Comm.Health Martinsbu
Shippensburg Civic Center
Shriners Hospital Outreach Clini
Simply Kidz Health Center
Smile Design Centre
Smithsburg Family Medical Center
Soma Medical Center
Somerset Dental Assoc- Somerset
Southside Pediatrics
Spencer Dental- Norfolk
St Petersburg Pediatrics
St. Christophers Otolaryngology
St. Christophers Ped. Pulmonary
St. Christophers Pediatric Assoc
Stay Well Health Center
Stroke Survivor Support Group
Summit Care Discount Program
Summit ENT & Hearing services
Summit Family Dental
Summit Health Support Group- WBO
Summit Health Support Groups
Summit Health Surgeons Serv.
Summit Physcian Services
Summit Primary Care -Bldg #2
Summit Primary Care At 8th St.
Summit Primary Care- GRN
Summit Primary Care- MBG
Summit Primary Care- Menno Hvn
Summit Primary Care- Mont Alto
Summit Primary Care- WYBO
Summit Primary Care-Shippensburg
Summit Urgent Care- Greencastle
Summit Womens Group- CHBG
Super Smiles Kids Dental
Sweetgrass Pediatrics
The Children's Doctor-Hagerstown
The Practice of Pediatrics
Thurmont Family Dentistry
Tri-State Comm Health Center
Triad Adult & Pediatric Medicine
Triad Kids Dental- Guilford
Trinity Pediatrics
True Health
U of P School of Dental Medicine
University Pediatric Group
Up Town Family Dentistry
UPMC CCP Hummelstown
UPMC CCP- Bedford Cessna
UPMC Children's Specialists-Nero
UPMC Community Health Children
UPMC For You
UPMC Hershey Pediatric Center
UPMC Ped-South Hills Mon Valley
UPMC Pediatric Cardiology
UPMC Pediatrics Shippensburg
UPMC Pediatrics- Bedford
UPMC Pediatrics-Heritage
UPMC Primary Care Chambersburg
UPMC Primary Care Phoenix Drive
UPMC Wellsboro Office Pediatrics
Valley Dental Assoc-Hagerstown
Wade Family Dentistry
Walter Advanced Dental Care
Walter Reed National Medical Ctr
Wayne Heights Dental
Waynesboro Comm. Health Nurse
Waynesboro Diaper Bank
Waynesboro Family Medical Assoc.
WBO Family Medical Assoc.
Wellmon Medical Associates
Wellness Family Med- Thurmont
WellSpan Cardiology- 22 St. Paul
WellSpan Chambersburg Hospital
WellSpan Endocrinology
WellSpan ENT & Hearing- Carlisle
Wellspan ENT & Hearing- CHBG
WellSpan Fam. Med- Frederick St.
WellSpan Fam. Med- O'Donnell
WellSpan Fam. Med-Penn National
WellSpan Family Med- Fairfield
Wellspan Family Med- Greencastle
Wellspan Family Med- Mercersburg
WellSpan Family Med- Phil. Ave.
WellSpan Family Med- Waynesboro
WellSpan Family Med-Littlestown
WellSpan Family Med.- Mont Alto
Wellspan Family Medicine- SHBG
WellSpan Family Medicine- Thomas
WellSpan Health & Surgery Center
WellSpan Imaging- Chambersburg
WellSpan Imaging- Greencastle
WellSpan Imaging- Shippensburg
WellSpan Imaging- Waynesboro
Wellspan Internal Med- Scotland
WellSpan Internal Med- V-Twin Dr
WellSpan Lab Services
WellSpan Lab- CHBG Hospital
WellSpan Lab- Gettysburg
Wellspan Maternal-Fetal- CHBG
Wellspan Maternal-Fetal- York
Wellspan Neurology- CHBG
WellSpan OB/GYN- Queen St.
WellSpan OB/GYN- WBO
WellSpan Ped Neurology Gettysbur
WellSpan Ped. Neurology- York
WellSpan Pediatric- East Market
Wellspan Pediatric- S. Queen St.
WellSpan Pediatric- Shrewsbury
Wellspan Philhaven- Gettysburg
WellSpan Philhaven-Meadowlands
WellSpan Podiatry- CHBG
WellSpan Rehab- Orchard Drive
WellSpan Rehab- Waynesboro
WellSpan Rehabilitation- CHBG
WellSpan Rehabilitation- SHBG
WellSpan Urgent Care Greencastle
WellSpan Urgent Care- CHBG
WellSpan Urgent Care- Waynesboro
WellSpan Urology- Chambersburg
WellSpan Urology- Waynesboro
WellSpan Waynesboro Hospital
WellSpan York Hosp Dental Center
Welsh Mountain Health Centers
Westover Hills Pediatric
Williamsport Dental Office
Willis Eye Hospital
Wolter Advanced Dental Care
Women, Infant and Children
WSH CP Quest Lab
WV Pediatric Dentistry
WVU Family Medicine- Berkeley
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 (Requerido)
Adamson Family Dentistry
Advanced Pediatric Dentistry
Advanced Pediatric Dentistry
Allegany Dental Care- Smithsburg
Amir Rabiee, DDS-Dental Surgery
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
CCAP- Community Action Program
Chambersburg Dental Assoc
Chambersburg Family Dentistry
Chesapeake Ped. Dental- Dundalk
Chesapeake Ped. Dental- Hanover
Children's Dental Centre 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
Clinic For Children PA
Cornerstone Dental Health
Covenant Family Dentistry
Crestwood Comprehensive Dental
Cumberland Valley Dental Care
Dental Dreams
Dental Health of Silver Springs
Dental Solutions of Chambersburg
Doreen K. Weeks, PHDHP
Dr. Manish Lakkad, DMD
Dr. Alexander J. McKinley
Dr. Jack Steele, DMD
Dr. Jacqueline Fogal, DDS
Dr. Jaime Horne, DDS
Dr. James J. Rosen Jr., DDS
Dr. Jay Blickenstaff, DDS
Dr. Jeffrey Pearlman, DDS
Dr. Jennifer K. Hargleroad, DDS
Dr. Joel Cortes, DDS
Dr. John Beall, DDS
Dr. John Palm, DDS
Dr. Johnny Joseph, DMD
Dr. Kristie Engler, DDS
Dr. Melvin Barber, DDS
Dr. Michael D. Cerveris, DMD
Dr. Michael R. Denning, DDS
Dr. Rachel Kendall, DMD
Dr. Reza Keshmiri, DDS
Dr. Robert Wennick Jr.
Dr. Robert Zimmerman, DDS
Dr. Victor N. Amarteifis, DDS
Elite Dental- Darby
Elite Dental-Allegheny
Family First Health-Dental GTBG
Family Healthcare Of Hagerstown
Family-yes but NO Name Provided
First Choice Dental Care
Fountain Head Dentistry
Frankford Ave Dental Center
Frederick Pediatric Dental Assoc
Frederick Pediatric Dentistry
Gettysburg Dental Associates
Greencastle Family Dental
Guilford Hills Dental Care
GW Thorne and Hollingshead
Hagerstown Family Dental
Hagerstown Smiles Dental Care
Hanover Pediatric Dentistry
Healthy Smiles Comm. Oral Health
Hearthside Family Dental
Hughes & Hughes Family Dentistry
Huntingdon Family Dentistry
Jerome Kids Dental
Just Kids Dental- Gettysburg
Kearns & Ashby Pediatric Dentist
Keystone Dental Care
Keystone Dental Mont Alto
Keystone Pediatric Dental
Kids Dental Clinic
Kool Smiles
Lancaster Clef Palate Clinic
Lancaster Co. Ped. Dentistry
Longmeadow Family Dental Care
MagicLand Pediatric Dental
Mary's Center
Mechanicsburg Family Dental
Mercersburg Family Dentistry
Morgan County Universal
Muller Family Dental
Nicole C Buzzi, DMD
NOVA Dental
Oak Landing Pediatric Dentistry
Oral Health Impact Project
PA Dental Association
Pediatric Dental Assoc Allegheny
Pediatric Dental Ctr Frederick
Pediatric Dental- Port Matilda
Pediatric Detistry Of Bronx
Phoenix Dental Care LLC
Pine Dentistry- Hagerstown
Porter Dental- Baltimore
Potomac Dental Centre
Precious Smiles- Carlisle
Pristine Smiles Family Dentistry
Reading Children's Health Center
Rivercity Dental- Williamsport
Robinwood Dental- Hagerstown
Sage Dental Of Buford
Smile Design Centre
Smilehaus Pediatric Dentistry
Somerset Dental Assoc- Somerset
Spencer Dental- Norfolk
Summit Care Discount Program
Summit Family Dental
Super Smiles Kids Dental
The Children's Doctor-Hagerstown
Thurmont Family Dentistry
Triad Kids Dental- Guilford
True Health
U of P School of Dental Medicine
Up Town Family Dentistry
UPMC Community Health Children
UPMC Ped-South Hills Mon Valley
Valley Dental Assoc-Hagerstown
Wade Family Dentistry
Walter Advanced Dental Care
Wayne Heights Dental
WellSpan Health & Surgery Center
WellSpan Mobile Dental
WellSpan York Hosp Dental Center
Westover Hills Pediatric
Williamsport Dental Office
Wolter Advanced Dental Care
WV Pediatric Dentistry
¿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 2025-2026
First Start Partnerships 2024-2025
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
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- Su Dirección
- Ubicaciones disponibles
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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. Por favor tenga en cuenta que estamos recibiendo un alto volumen de solicitudes en este momento y es posible que experimente un tiempo de espera más largo de lo normal para ser contactado para completar el proceso de inscripción. Sepa que estamos trabajando arduamente para procesar todas las solicitudes y nos pondremos en contacto con usted tan pronto como podamos. Gracias por colaborar con nosotros para asegurar que su hijo llegue preparado para el jardín de niños.
Información requerida falta, por favor revisa.