Contact Us - South Carolina Child Care Inclusion Collaborative

Anticipated Program Start Date

Description of Child’s Significant Health Need

Age of Child (Corrected)

0 months - 3 months

3 months – 6 months

6 months - 9 months

9 months – 12 months

Is your child currently admitted to the NICU?

Yes

No

Date of discharge from NICU

Indicate individual interested in participating in the training

Caregiver

Parent

Are you interested in learning about additional resources for your child for management of significant healthcare needs?

Yes

No