Welcome to Neighborhood House Child Development programs. Please complete this online application to apply for one of our programs. If you have any questions, please contact us at 206-461-8430 Ext-2041 Once you submit, a staff person will contact you within the next 2 business days. We look forward talking with you.
Parent/Guardian
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
Afar
American Sign Language
Amharic
Arabic
Barawa
Bemba
Bengali
Berma
Burmese
Cambodian
Cantonese
Cham
Chin
Chinese
Chuukes
Creole
Dari
English
Farsi
French
Fur
German
Japanese
Karen
Khmer
Kiswele
Korean
Kunama
Laotian
Maka
Mandinka
Mayan
Nepali
Oromo
Pashto
Polish
Punjabi
Romanian
Russian
Samoan
Somali
Soninke
Spanish
Swahili
Tagalog
Tamil
Tigrinya
Urdu
Vietnamese
Wolof
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
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
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
Afar
American Sign Language
Amharic
Arabic
Barawa
Bemba
Bengali
Berma
Burmese
Cambodian
Cantonese
Cham
Chin
Chinese
Chuukes
Creole
Dari
English
Farsi
French
Fur
German
Japanese
Karen
Khmer
Kiswele
Korean
Kunama
Laotian
Maka
Mandinka
Mayan
Nepali
Oromo
Pashto
Polish
Punjabi
Romanian
Russian
Samoan
Somali
Soninke
Spanish
Swahili
Tagalog
Tamil
Tigrinya
Urdu
Vietnamese
Wolof
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
Afar
American Sign Language
Amharic
Arabic
Barawa
Bemba
Bengali
Berma
Burmese
Cambodian
Cantonese
Cham
Chin
Chinese
Chuukes
Creole
Dari
English
Farsi
French
Fur
German
Japanese
Karen
Khmer
Kiswele
Korean
Kunama
Laotian
Maka
Mandinka
Mayan
Nepali
Oromo
Pashto
Polish
Punjabi
Romanian
Russian
Samoan
Somali
Soninke
Spanish
Swahili
Tagalog
Tamil
Tigrinya
Urdu
Vietnamese
Wolof
Is another language being acquired or learned at home?
Yes
No
Number in Family
Gross Annual Income
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
Afar
American Sign Language
Amharic
Arabic
Barawa
Bemba
Bengali
Berma
Burmese
Cambodian
Cantonese
Cham
Chin
Chinese
Chuukes
Creole
Dari
English
Farsi
French
Fur
German
Japanese
Karen
Khmer
Kiswele
Korean
Kunama
Laotian
Maka
Mandinka
Mayan
Nepali
Oromo
Pashto
Polish
Punjabi
Romanian
Russian
Samoan
Somali
Soninke
Spanish
Swahili
Tagalog
Tamil
Tigrinya
Urdu
Vietnamese
Wolof
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
PCHP 2020-2021
Head Start 2020-2021
ECEAP 2020-2021
Early Head Start 2020-2021
1st Location Preference
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2nd 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
Thank you for submitting your application. Next please have the following documents ready and upload in the system. 1. Proof of Age 2. Proof of Income 3. Proof of Residency
Required information is missing, see above.