Francis Howell School District Parents as Teachers Enrollment
Parents as Teachers is a FREE program for families with children (prenatal until Kindergarten entry).

To enroll in Parents as Teachers, please complete and submit this form.

Once you submit this form, please click on the link at the end to finish your enrollment with the Francis Howell School District.
Sign in to Google to save your progress. Learn more
Email *
Person filling out this form is: *
1st Guardian's First Name *
1st Guardian's Last Name *
1st Guardian's relationship to child *
Required
1st Guardian's Street Address *
1st Guardian's City *
1st Guardian's Zip Code *
1st Guardian's Phone Number *
1st Guardian's Preferred Method of Contact *
Required
1st Guardian's Ethnicity (click all that apply) *
Required
Primary Language Spoken in the Home (more than 50%) *
Adult(s) the child(ren) lives with? (click all that apply)
2nd Guardian's First Name
2nd Guardian's Last Name
2nd Guardian's relationship to child
2nd Guardian's Email Address
2nd Guardian's Phone Number
2nd Guardian's Preferred Method of Contact
2nd Guardian's Ethnicity (click all that apply)
Check which days of the week, Monday-Friday, you are available for daytime appointments BEFORE 4:30 p.m. *
Required
Check which days of the week, Monday-Friday, you are available for evening appointments AFTER 4:30 p.m. (evening appointments are limited) *
Required
Comments concerning availability for appointments:
1st Child's Legal Name (First) *
1st Child's Legal Name (Middle)
1st Child's Legal Name (Last) *
1st Child's Ethnicity *
Required
1st Child's Birth Date *
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1st Child's Gender *
2nd Child's Legal Name (First)
2nd Child's Legal Name (Middle)
2nd Child's Legal Name (Last)
2nd Child's Ethnicity
2nd Child's Birth Date
MM
/
DD
/
YYYY
2nd Child's Gender
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3rd Child's Legal Name (First)
3rd Child's Legal Name (Middle)
3rd Child's Legal Name (Last)
3rd Child's Ethnicity
3rd Child's Birth Date
MM
/
DD
/
YYYY
3rd Child's Gender
Clear selection
Do you have any specific area of need or concern?
Does your family receive supports from Social Service Agencies? *
If your family does receive supports from Social Service Agencies, please tell us which agencies.
What is your last year of school completed? *
Where did you learn about our programming?
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Have you ever participated in Parents as Teachers before?
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If yes, where did you participate in PAT?
A copy of your responses will be emailed to the address you provided.
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