Apply Online

Thank you for your interest in Easterseals Early Head Start (EHS) and Head Start (HS) program! By taking this step, you are putting your baby’s best foot forward in life.

Early Head Start serves pregnant women and children up to age four. Because so much important growth and development happens in this stage of a child’s life, EHS is here to help you learn how to be the best parent you can be! The tools you and your child will gain from your participation in EHS will benefit you both as you grow and learn together.

Enrollment into Easterseals Early Head Start and Head Start program is ongoing, but eligibility depends on:

Need

Where you live

Your income level

Complete the application below to see if you qualify!

Please enter the demographic information of the Primary Parent/Guardian.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender (Required)

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 (Required)

Opt In for Text Messages

Home Phone (Required)

Work Phone (Required)

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

Employment Status

Recruitment Efforts (Required)

Please enter your current address.

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.

Please enter the demographic information of the Secondary Parent/Guardian.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender (Required)

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

Employment Status

Are there other adults in the household?

Add Another Adult

Primary Language at Home (Required)

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

Please enter the demographic information of the Child who you wish to apply for.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender (Required)

Race

Hispanic

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

Click here to find a provider in your area.

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

Add Another Applicant

Are there other children in the family?

Add a Sibling

Thank you for applying to see if you qualify for Easterseals Early Head Start (EHS) and Head Start (HS) program.

After you click the “Submit Application” button below, you will receive an email confirming that your application has been received. A staff member will contact you after submission of online application. Your selected Program can be changed at a later date, if needed.

We appreciate your interest in joining the program and look forward to speaking with you!

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings