Apply Online

Please complete the form below to begin your application process for the Head Start Program with Easterseals Early Learning Services. Please be sure to provide current and accurate information regarding your child and family, as this will ensure the application process goes as quickly as possible. Completing this form is the first step in the application process. A member of our team will be in contact with you after your interest form is submitted. If you need to speak with a staff member sooner or have an urgent matter, please call us at 708-330-4490.

The primary adult must live in the home with the child applicant.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Child's Relationship

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Primary Language at Home

Is another language being acquired or learned at home?

Child Applicant Information

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Doctor/Medical Home

Dentist/Dental Home

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

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Do you want to apply now for another child in your family?

Add Another Applicant

Thank you for your interest in the Head Start Program. By clicking the button below, you certify that the information you have provided is complete and accurate. We will contact you in the next 2-3 business days to set up an intake appointment.

Required information is missing, see above.

Parent/Guardian

Address

Family Information

Child (Applicant)

Location Preferences

Additional Applicant