Thank you for your interest in the EWU Early Head Start program! Please complete one application for each applying child (age 0-3) or pregnant parent. *NOTE: If your family has been enrolled in EWU EHS before, please contact us toll-free at 1-800-776-9136 to apply again.
Parent/Guardian
Complete this section for the parent/guardian that will be participating most frequently in EWU EHS home visits:
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender (Required)
Female
Male
Non-binary
Not specified
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
Yes
No
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 (Required)
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic (Required)
Yes
No
Lives with Family (Required)
Yes
No
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
African (Swahili, Wolof)
American Sign Language
Caribbean Language (Haitian-Creole, Patois)
East Asian (Chinese, Vietnamese, Tagalog)
English
European/Slavic (German, French, Russian)
Middle East/South Asian (Arabic, Hebrew, Hindu, Urdu)
Native Central/South American (Mixteco, Quichean)
Native North American/Alaska Native
Other Language (specify)
Pacific Islands (Palauan, Fijian)
Parent declined to identify language
Spanish
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed (Required)
Associate's Degree
Bachelor's Degree or higher
General Education Diploma
High School Graduate
Less than high school diploma
Prefer not to report
Some college/training
Technical Training or Certification
Unknown
Employment Status (Required)
Full-time (35 hours/week or more)
In job training
In school
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Unemployed
Child's Relationship (Required)
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody (Required)
Yes
No
Marital Status
Married
Never married
Not married but living together
Separated/divorced/widowed
Housing Status
Lives in public housing
Lives with parent or family member
Living in an emergency or transitional shelter
Owns or shares home, condo, apt
Rents or shares own home or apt
Sharing housing due to loss of housing, economic hardship, or similiar reason
Some other arrangement
Health Insurance
Medicaid/CHIP
No insurance coverage
Private or other insurance
Tricare
Address
Please provide your family's living and mailing address. If your family is residing somewhere temporarily, enter the address of the location where your family stays overnight (e.g., at a friend's home, at a shelter).
Is your family experiencing homelessness?
Yes
No
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
Additional Parent/Guardian
Complete this section for another parenting adult in your household:
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender (Required)
Female
Male
Non-binary
Not specified
Email Address
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
Yes
No
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 (Required)
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic (Required)
Yes
No
Lives with Family (Required)
Yes
No
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
African (Swahili, Wolof)
American Sign Language
Caribbean Language (Haitian-Creole, Patois)
East Asian (Chinese, Vietnamese, Tagalog)
English
European/Slavic (German, French, Russian)
Middle East/South Asian (Arabic, Hebrew, Hindu, Urdu)
Native Central/South American (Mixteco, Quichean)
Native North American/Alaska Native
Other Language (specify)
Pacific Islands (Palauan, Fijian)
Parent declined to identify language
Spanish
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed (Required)
Associate's Degree
Bachelor's Degree or higher
General Education Diploma
High School Graduate
Less than high school diploma
Prefer not to report
Some college/training
Technical Training or Certification
Unknown
Employment Status (Required)
Full-time (35 hours/week or more)
In job training
In school
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Unemployed
Child's Relationship (Required)
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody (Required)
Yes
No
Marital Status
Married
Never married
Not married but living together
Separated/divorced/widowed
Housing Status
Lives in public housing
Lives with parent or family member
Living in an emergency or transitional shelter
Owns or shares home, condo, apt
Rents or shares own home or apt
Sharing housing due to loss of housing, economic hardship, or similiar reason
Some other arrangement
Health Insurance
Medicaid/CHIP
No insurance coverage
Private or other insurance
Tricare
Family Information
Primary Language at Home (Required)
African (Swahili, Wolof)
American Sign Language
Caribbean Language (Haitian-Creole, Patois)
East Asian (Chinese, Vietnamese, Tagalog)
English
European/Slavic (German, French, Russian)
Middle East/South Asian (Arabic, Hebrew, Hindu, Urdu)
Native Central/South American (Mixteco, Quichean)
Native North American/Alaska Native
Other Language (specify)
Pacific Islands (Palauan, Fijian)
Parent declined to identify language
Spanish
Spanish
Is another language being acquired or learned at home?
Yes
No
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program? (Required)
Yes
No
Is your family receiving Supplemental Security Income (SSI)? (Required)
Yes
No
Is your family receiving services from WIC? (Required)
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps? (Required)
Yes
No
Is at least one parent/guardian an active duty member of the United States military? (Required)
Yes
No
Is at least one parent/guardian a veteran of the United States military? (Required)
Yes
No
Child (Applicant)
Please complete this section for the applying child. *NOTE: If the child has not yet been born, please enter "Unborn" as the name of the child and "1/1/2024" as the birth date. This will help identify the applicant as a pregnant woman.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Non-binary
Not specified
Race (Required)
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic (Required)
Yes
No
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
African (Swahili, Wolof)
American Sign Language
Caribbean Language (Haitian-Creole, Patois)
East Asian (Chinese, Vietnamese, Tagalog)
English
European/Slavic (German, French, Russian)
Middle East/South Asian (Arabic, Hebrew, Hindu, Urdu)
Native Central/South American (Mixteco, Quichean)
Native North American/Alaska Native
Other Language (specify)
Pacific Islands (Palauan, Fijian)
Parent declined to identify language
Spanish
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage (Required)
Children's Health Insurance Program (CHIP)
Medicaid
Other
Private Health Insurance
State-Only Funded Insurance
Other Coverage
Children's Health Insurance Program (CHIP)
Medicaid
Other
Private Health Insurance
State-Only Funded Insurance
Doctor/Medical Home (Required)
DISABILITY Spokane Eye Clinic
DISABILITY Spokane Valley ENT
DISABILITY Stepping Stones
DISABILITY Youthful Horizons
FOOD WIC
HEALTH NETCHD
HEALTH Panhandle Public Health
MEDICAL Achieve Ped Therapy
MEDICAL Airway Pediatrics
MEDICAL Birth By Design Midwife
MEDICAL Camas Center Clinic
MEDICAL Centennial Pediatrics
MEDICAL CHAS Clinic
MEDICAL Chewelah Assoc Physician
MEDICAL Confluence Health
MEDICAL Deaconess Hospital
MEDICAL Deer Park Family Care
MEDICAL Deer Park Urgent Care
MEDICAL Full Circle Health & Wel
MEDICAL Holy Family Hospital
MEDICAL Inland Imaging
MEDICAL Lake Roosevelt Comm Hlth
MEDICAL Lakeside Pediatrics
MEDICAL Mid-Valley Clinic
MEDICAL Mount Carmel Hospital
MEDICAL Mount Spokane Pediatrics
MEDICAL Multicare Rockwood
MEDICAL NEW Health Clinic
MEDICAL Newport Health Center
MEDICAL Newport Hospital
MEDICAL North Spokane Womens Hx
MEDICAL Northwest Pediatrics
MEDICAL NW Peds Opthalmology
MEDICAL Pediatrics NW Clinic
MEDICAL Providence Clinics
MEDICAL Range Community Clinic
MEDICAL Republic Medical Clinic
MEDICAL Sacred Heart
MEDICAL Saturn Clinic
MEDICAL Seattle Swedish
MEDICAL Serenity Midwives
MEDICAL Serenity Widwives
MEDICAL Shriners Hospital
MEDICAL Spokane Asthma-Allergy
MEDICAL Spokane Audiology Clinic
MEDICAL Spokane ENT
MEDICAL Spokane OB/GYN
MEDICAL Spokane Pediatrics
MEDICAL Spokane Teaching Health
MEDICAL St. Joseph'S Hospital
MEDICAL The Doctors Clinic
MEDICAL The Kids Clinic
MEDICAL Unify Community Health
MEDICAL Valley Young People
MEDICAL Wellpinit Indian Health
SCHOOL READ Cntr For Ped Ther
SCHOOL READ ESIT-ESD 101
Dental Coverage
Children's Health Insurance Program (CHIP)
Medicaid
Other
Private Health Insurance
State-Only Funded Insurance
Dentist/Dental Home
DENTAL 7 Day Dental Smiles
DENTAL Apple Valley Dental
DENTAL Banich Family Dental
DENTAL Bates DDS Dentistry
DENTAL Breeden, James DDS
DENTAL Bright Now Dental
DENTAL Burke, John DDS
DENTAL Call, Steven DDS
DENTAL Camas Center Clinic
DENTAL CHAS Clinic
DENTAL Children's Choice Dental
DENTAL Children's Dental Village
DENTAL Colville Community Dental
DENTAL Colville Pediatric Dent
DENTAL Condon, Michael DDS
DENTAL Curtis Orthodontics
DENTAL Dance Dentistry For Kids
DENTAL Deer Park Dental
DENTAL Division Street Dental
DENTAL Gentle Dentistry
DENTAL Grillo Robeck Dental
DENTAL Hardwick Family Dentistry
DENTAL Harmony Holistic Dent
DENTAL Healthy Expressions Dent
DENTAL Inspire Advanced Dent
DENTAL Ivory Dental Clinic
DENTAL Jarvis, DDS
DENTAL Johnson Dental
DENTAL Kettle Falls Dentistry
DENTAL KidSmile
DENTAL Lake Spokane Community
DENTAL Leng, John DDS
DENTAL Mint Condition Dental
DENTAL Moffitt Childrens Dentist
DENTAL Molly Gunsaulis Dentistry
DENTAL NEW Health
DENTAL Newport Dental & Assoc
DENTAL Northpointe Family Dent
DENTAL Northview Family Dental
DENTAL Sandpoint Kids Dentistry
DENTAL Sleep Dentistry
DENTAL Smiles Of Spokane
DENTAL South Hill Pediatric Dent
DENTAL Spokane Pediatric Dentist
DENTAL Sunrise Dental
DENTAL The Kidds Place
DENTAL Unify Community Health
DENTAL Unify Dental
DENTAL Von Tracy Dentistry
DENTAL Weiand And Weiand, DDS
DENTAL Willamette Dental Clinic
MEDICAL Valley Young People
MEDICAL Wellpinit Indian Health
Does your child have a disability or do you have any concerns about your child's development? (Required)
Yes
No
Is there anything else you want to tell us about your child?
How did you hear about us
Billboard
Brochure or flyer
CASA
Community member
CPS
DCFS
DSHS
Early Learning Center
EHS event/outreach
EHS family
EHS staff
EHS website
ESIT
Facebook
Family member
Friend
Head Start
Health District
Medical provider
Newspaper
Other
Previously enrolled in EHS
Rural Resources
School
WIC
Location Preferences
Which program are you applying for? (Required)
EWU EHS 2024-25 School Year
EHS for pregnant parents & children ages 0-3
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd Location Preference
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- Your Address
- Available Locations
Click a location on the map to see more info
Click here
to find a provider in your area.
Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Siblings
Are there other children in the family?
Add a Sibling
By clicking the button below you certify that the information you have provided is complete and accurate to the best of your knowledge. Please check your email for confirmation that your application was successfully submitted. We look forward to talking with you soon!
Required information is missing, see above.