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Enrollment Form

I am interested in the PAT Program

Best way to contact me

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I live in Dallas, Madison, or Warren County, Iowa.

I have a child age prenatal - three.

My family meets the income requirements, OR the education requirements (high school diploma or less OR my child has a IEP or IFSP.

My family does not meet the income, education, or IEP requirments, but we would like to be placed on your waiting list.

Thanks for submitting!

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