START STRONG PA - SIGN-UP

Start Strong PA is a statewide advocacy campaign to increase access to affordable, high-quality child care for Pennsylvania's families and their children through policy and investment.

We need early care and education professionals like you to help us inform and engage Pennsylvania policymakers for changes that will make these outcomes possible. Please sign-on to support Start Strong PA by completing the forms below.

Thank you for your willingness to join us in this effort.

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* 1. First Name

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* 2. Last Name

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* 3. Cell Phone Number

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* 4. Personal Email

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* 5. Home Address

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* 6. City

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* 7. State

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* 8. Zip

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* 9. Your Organization/Program

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* 10. Program's Phone Number

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* 11. Work Address

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* 12. Work City

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* 13. Work State

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* 14. Work Zip

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* 15. Age Groups You Serve

Infants

Toddlers

Pre-K

Kindergarten

School-Age

Not a child care provider, please explain below:

Other (please specify)

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* 16. Are you signing onto the campaign as an individual endorser?

Yes

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* 17. Are you signing on as an organizational endorser

Yes

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* 18. Do you have the authority to sign on to the campaign on behalf of your organization?

Yes