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Welcome!

Thank you for your interest in EPIC Early Learning Programs. Completing this Pre-Application helps us find the best program for your child. This is the first step in the process and does not guarantee enrollment.

How to Complete the Pre-Application for Early Learning Programs

Please fill out each section as thoroughly as possible.
Attachments are optional. You may upload documents to help speed up the enrollment process, but they are not required to submit your pre-application.
If you’re unsure about a question, you may leave it blank—our team will assist you during your enrollment meeting.

Once your pre-application is submitted, our Enrollment Team will review your information and contact you within 5 business days to schedule an eligibility interview or request additional documentation.

Primary Adult Section

Please enter information for the primary adult responsible for the child.

Take a moment to review your information to make sure everything is accurate before continuing.

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

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.

Lives with Family (Required)

English Proficiency (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

What area do you live in? (Required)

EPIC History (Required)

Referral Source (Required)

Are you pregnant? (Required)

Why we ask:

Our program is required to ask about your current living situation. This helps us connect families with helpful supports, such as transportation or housing resources. Your response is confidential and does not affect eligibility.

If you select “Yes” and do not have a permanent address, you may enter NA for your address and any other required fields in this section that do not apply to your situation.

Select “Yes” if any of the following apply:

You are temporarily staying with friends or relatives due to loss of housing or financial hardship.
You are staying in a hotel, motel, or shelter.
You are living in a car, park, campground, or other place not meant for housing.
You are in temporary or transitional housing.

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

Family Section Instructions

Please provide information about all members of your household. This helps us determine family size and program eligibility.

Include all adults and children living in your home, even if they are not applying for services.

Income

When asked about your household’s gross income, you may provide your best estimate if you do not know the exact amount. Our team will review and verify income during your appointment.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home? (Required)

Number in Household (Required)

Gross Annual Income

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

Is your family receiving Supplemental Security Income (SSI)? (Required)

Is your family receiving services from WIC? (Required)

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

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

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

Child Application Section Instructions

Please provide details about the child applying for services. This helps us determine eligibility and place your child in the appropriate program.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language (Required)

Primary Health Coverage (Required)

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

Is there anything else you want to tell us about your child?

Transportation Needed (Required)

Transportation Schedule (Required)

Preferred Hours (Required)

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

Thank you for taking the first step in your child’s early learning journey!
We look forward to working with you and your family.

Required information is missing, see above.

Welcome!

How to Complete the Pre-Application for Early Learning Programs

Parent/Guardian

Address

Family Information

Child (Applicant)

Location Preferences

Additional Applicant