Preschool for All (PFA) Screening
Please provide the below information in order to be added to our mailing list and to be notified of future screening dates. All children must be screened to be considered for entrance into the PFA program; placement is not guaranteed.

Email address *
Child's First Name *
Your answer
Child's Middle Name
Your answer
Child's Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Child's Gender *
Do you have concerns about your child's development? *
If yes, what concerns do you have?
Your answer
Parent/Guardian *
Your answer
Parent/Guardian
Your answer
Address *
Your answer
City *
State *
Zip Code
Your answer
Phone Number *
Your answer
Alternative Phone Number
Your answer
Native Language *
Required
Language at home *
Required
Ethnicity *
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