Provider Agreement for School Readiness Funded Services

Username (Email):

If you don't have an Email, you can get a
free Email address at Yahoo or Google.

Password:

Note: In order to add more than 1 provider agreement, login as usual with your email address and password. At the next screen, single click on "Add new agreement" (on the top menu), then provide the DCF ID/License number or phone number and zip code and single click on the "Add new agreement" button. If multiple agreements exist, clicking on "Provider Form" (on the top menu) will display a list of all agreements.

DCF ID / License #:

Or phone if you are exempt:

Phone:

And your ZIP code

Zip Code:

The above information will be used to verify
your Provider status in our system.

Username (Email):

If you don't have an Email, you can get a free Email address at Yahoo or Google.

Password:

Re-enter Password: