Please fill out all information in order to get your application started. Staff will be contacting you within one week to get the rest of your information.
If available, please use the mother of the child as the primary adult unless she is not living in the home.
Please complete the following information
Click here to find a provider in your area.

Are there other adults in the household?

Add Another Adult
please complete the following information. We will need a copy of your tax information, W2's, or any other income you may have in your household. We will be contacting you shortly for this information. Regarding your emergency contacts, you as parents or guardians will always be contacted first. These extra contacts can be grandparents, aunts/uncles, friends, etc. Please check whether we can contact them in case of an emergency AND if we have permission to release the child to them
Under the disability section - this is a child that is currently working with the Area Education Agency and has an IFSP or IEP

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 your interest in the Early Head Start, Head Start or CDC programs. Please click submit to finalize your application. We will contact you to set up an intake appointment.
Required information is missing, see above.