Home » Application – Pregnancy to Age Three (P-3) Home Visiting Program

2017-18 Board of Directors

  • Michael Giles, President
  • Kelsey Clark, Vice President
  • Mike Birrer, Treasurer
  • John H. Fullinwider
  • Amrit Kirpalani
  • Mary Caroline Parker, Secretary
  • Lecolion Washington, Sr.

Application – Pregnancy to Age Three (P-3) Home Visiting Program

Online Application for the Pregnancy to Age Three (P-3) Home Visiting Program

The P-3 program is a free service provided to families.  We are currently enrolling families that either live in the service area or have a sibling enrolled at one of our campuses or a sibling that is an alumni.

Only one child per application, please.



Are you pregnant and wish to enroll before the baby is born?

Expected date of delivery


If your baby has already been born, please give the following information:

Child's full name

Child's date of birth

Home phone

Child's primary address

City , State Zip

Does the child live in the service area (see image below)?


Parent/Guardian Information


Mother's name

Mother's Home phone

Mother's employer

Mother's Work phone

Mother's email

Mother's Cell phone



Father's name

Father's Home phone

Father's employer

Father's Work phone

Father's email

Father's Cell phone


Sibling Information

Does the child have a sibling who is 1) enrolled at any of our campuses, or 2) an alumni?

If yes, please give name(s) of sibling(s)

Year last enrolled

Number of Years enrolled


Parents and/or Guardian's Language

Would you prefer to have a Parent Educator who is fluent in Spanish?

Does the child hear, understand or speak a language other than English?

If yes, what language(s)?

How did you hear about the PAT program?


Additional information?

Please enter the characters below


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