English

Arabic

Chinese

Dutch

Essential Parenting

Offering 10 parental education sessions 24/7, by a trained Essential Parental Educator, (EPE) who supports expectant mothers, parents, grandparents, or guardians of children birth to nineteen(19)

Connect with one of our highly qualified Parental Educators

Effective Date : *

First Name *

Last Name *

Home Address *

City *

State

Zip Code *

Timezone:*

Gender *

Male

Female

Transgender

Gender not listed

Background * (Select all that apply)

View Disability

View Single Parent

Please select value from this button

Email Address *

User Password *

Confirm Password *

Mobile Number *

Please enter valid mobile number!

Emergency Contact First Name *

Emergency Contact Last Name *

Emergency Contact Phone Number *

Please enter valid mobile number!

Emergency Contact Email Address *

Emergency Relationship *

Number in family

Household Annual Income *

Do you have medical insurance? *

Yes

Insurance Name

Policy Number

Group Number

Do you have Private or Medicaid insurance

Private

Medicaid

Do you have the following

I-pad

Notebook

Desktop Computer

Cell Phone

None of These

Do you have access to the internet? *

Yes

Who is your internet provider

How would you rate your computer/internet skills? *

Beginner

Intermediate

Expert

Age of child(ren) who you need support with: *

Is the child male?

Yes

Is the child female?

Yes

Does the child have an IFSP (Individualized Family Service Plan for Children 0-3)

Yes

Does the child have an IEP (Individualized Education Plan for children 3 and older)

Yes

Heard about program*

Primary Language*

Race Ethnicity*

Spiritually oriented*

Yes

LGBTQ friendly*

Yes

Check all that apply*

What qualities in an Essential Parental Educator do you prefer?

Flexible

Organized

Warm

Competent

Ideas

Empathetic

Honest

Impactful

Dependable

Kind

Open-Minded

Independent

Concerned

Active

Inspirational

Solving Problems

Making Sense

Easy Going

Hands On

Do things Right

If at anytime you are not satisfied with your Home Visting Provider, you can choose a new provider from your suggested list

Report a Problem

Do you need special arrangements?

Yes

Select Single Parent

119822 Individuals/Families Helped