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Welcome to Futures Unlimited, Inc.! You have landed on our application page for Early Childhood Services for children and families ages prenatal to 5. This includes:

Early Head Start (prenatal thru age 2)
Preschool/Head Start/Pre-K/Special Education (ages 3-5)

By completing the application below, you are taking an important step in your child’s future. Our programs are proven to set the stage for a child’s development and life success. To learn more about our programs, CLICK HERE.

You will want to have the following information handy as you complete the application: health insurance, dental insurance and your gross annual income. If you have questions, feel free to contact Cindy Bauer at cindyb@futures-unlimited.org or 620-326-8906 x245. Thank you for your interest. We look forward to working with your family.

Primary adult is the parent/guardian member that is filling out application or parent/guardian that has residential custody. **If the primary or secondary adult has applied previously or been involved in a program with Futures Unlimited Early Childhood, please call number below before entering any information to avoid duplication of family file. (programs include, tiny-k, Early Head Start, Pre-k, Head Start or Special Education) 620-326-8906 ext. 245

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

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

The term homeless means individuals who lack a fixed, regular, and adequate nighttime residence, sharing housing with other persons due to loss of housing, economic hardship or a similar reason.

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

Address Line 2

City

State

ZIP

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Are there other adults in the household?

Add Another Adult

Early childhood programs that are income based will be verified during a scheduled appointment with the Early Childhood Enrollment Specialist.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Family

Gross Annual Income

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 complete all information for the child that you are applying for. If you need to apply for another child you will have that option before you submit this application. PRENATAL: for child's first name enter NEW BABY and baby's last name, DATE OF BIRTH is your due date. This information will be corrected once baby has arrived.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Insurance Number

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Which program are you applying for? (Required)

1st Location Preference

2nd 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 submitting your application. Cindy Bauer will review your information and contact you to set up an appointment to verify your income, proof of birth of child(ren) and proof of address. If you have additional questions please contact her at (620) 326-8906 ext. 245. We comply with applicable federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability or sex.

ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (620)326-8906.

CHÚ Ý: N?u b?n nói Ti?ng Vi?t, có các d?ch v? h? tr? ngôn ng? mi?n phí dành cho b?n. G?i s? (620)326-8906.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings