Contents -

Section 1:  Applicant Information (page SB0130)

Complete the details for the applicant on the PATH Child Care Authorization:  Section 1 - Applicant Info page (SB0130) as described below.  Complete the following information on this page.

Last*, First* and Middle Names and Suffix

Enter the name of the applicant in the appropriate name fields. 

Application Date

Enter the date which appears on the PATH Authorization in this field.

SSN (Social Security Number)*

The Social Security Number will be populated from the data transferred from PATH to Bright Futures.  This is not a system entry field.

SSN Verified

This field will be defaulted to Yes because of the transferred data from PATH to Bright Futures.  This is not a system entry field.

ISN

The unique identifier assigned to all clients in the PATH system will be populated from the data transferred from PATH to Bright Futures.  This is not a system entry field.

Home Address*

Enter the first line of the Address in this field.

Address Line 2

Enter the second line of the Address in this field.

City

Type the name of the city in this field.

State*

The State has been defaulted to Vermont; however if another selection is needed, select the name of the state by using the down arrow () next to the field.

Zip Code*

Enter the zip code in this field using the format #####-####.

Town of Residence*

Select the name of the town by using the down arrow () next to the field.

Date of Birth*

Enter the date of birth using the following format MM/DD/YYYY.

Gender*

Select Female or Male by using the radio button next to the field ().

Marital Status

Select the value for the marital status by using the down arrow () next to the field:

Civil Union

Divorced

Married

Single

Single with Domestic Partner

Widow or Widower

Single Parent

Select either Yes or No for the selection by using the radio button next to the field (). 

Race

Check each of the race categories that apply by clicking in the box next to the value:

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Pacific Islander

White

Ethnicity

Select either Hispanic or Non-Hispanic for the selection by using the radio button next to the field (). 

Primary Language

Select the value for the primary language by using the down arrow () next to the field.  The language will be defaulted to English.

American Sign Language

Bosnian

Chinese

English

French

Somalian

Spanish

Vietnamese

More:

Contact Information (PATH)

Submitting Section 1of the PATH Authorization