HIPPY Interest & Eligibility form Home Instruction for Parents of Preschool Youngsters (HIPPY) HIPPY Interest & Eligibility form HIPPY - Interest and Eligibility Form Thank you for your interest in the HIPPY Pasadena program!Thank you for your interest in the HIPPY Pasadena program!Please fill out the information below to determine if you qualify for HIPPY Pasadena.Your child must turn 2 years of age by October 31 and you, and your family must reside within the Pasadena, Altadena, or Sierra Madre area to qualify for the program.If you are unsure whether you qualify, fill out the form and a Parent Specialist will contact you with additional information.Once you complete the information below, a Parent Specialist will contact you between 2-3 business days. Completion of this form does not mean you are enrolled in the program. Parent Specialists work directly with parents/caregivers and not with children. Parents are their child's first teachers.Your name * Your name First First Last LastYour child's name * Your child's name First First Last Last Child’s date of birth * Phone number where we can reach you * Email * What is your zip code? * Parent primary language * English Spanish OtherOtherPreferred Method of Contact * Phone EmailPreferred time for meetings * Morning Afternoon Evening How did you hear about HIPPY Pasadena? * Is your child currently enrolled in a preschool program? (Enrollment in HIPPY Pasadena does not affect standing in preschool or other programs.) * Head Start preschool program Public preschool program (i.e. Pasadena Unified School District) Private preschool Day care (family home) Day care (center) Not currently enrolled in daycare or preschool OtherOther Name of preschool or day care (if applicable) Parent/Guardian's Highest Level of Education * Less than High School Some High School High School Diploma or GED Professional or Trade Certificate Some College Associate’s Degree Bachelor’s Degree Master’s Degree or higherPlease check if you are eligible/currently enrolled in one or more of the following programs (select all that apply): Medi-Cal (Click here to determine if you’re eligible) Women, Infants & Children (WIC) (Click here to determine if you’re eligible) CalFresh (Click here to determine if you’re eligible) CalWorks (Click here to determine if you’re eligible)After you hit SUBMIT button below, your interest form will be submitted and you will receive a confirmation of your submission. Please, avoid submitting duplicate requests. If you are human, leave this field blank. SubmitΔ