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Thank you for your interest in Seton Hill Child Services, Inc! We are excited to provide you with quality care and education for your child! If you need assistance filling out this application, please call (724) 836-0099. If you are applying for Early Head Start, Head Start, or Pre-K Counts, please be sure to provide your household income for eligibility. When meeting with the Family Resource Specialist for enrollment, you will be required to provide proof of income (12 months prior to application date), proof of cash assistance, SSI documentation, SNAP card or Foster Placement letter to be considered for the program. PLEASE COMPLETE ALL AREAS OF THE APPLICATION!

PLEASE COMPLETE ALL AREAS

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

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

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

PLEASE COMPLETE ALL AREAS

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

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

PLEASE COMPLETE ALL AREAS *You are not required to fill out household income if you are applying for the Private Program, however, Early Head Start, Head Start, and Pre-K Counts Programs require income verification. For those programs please fill out the income section with the last 12 months of income. Please remember a Family Resource Specialist will call upon enrollment to ensure you have your proof of income (12 months prior to application date), proof of cash assistance, SSI documentation, SNAP card, or Foster Placement letter to be considered for the program. All documents and information that are received by SHCS will be kept confidential.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Household

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?

Add Emergency Contact

PLEASE COMPLETE ALL AREAS. In the area for additional notes please provide us with the School District in which you reside. All information is kept confidential.

First Name (Required)

Middle Name

Last Name (Required)

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Primary Health Coverage

Insurance Number

Doctor/Medical Home

Dentist/Dental Home

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

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

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

Are there other children in the family?

Add a Sibling

Thank you for your interest in Seton Hill Child Services, Inc. Please make sure all areas of your application are completed then click submit to finalize your application. The Family Resource Specialist will contact you at their earliest convenience to set up an enrollment appointment.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings