Thank you for choosing Early Head Start in partnership with The Community Group of Lawrence. This program serves children from birth - 3 years old. Program options include Family Child Care and Center-Based programs. *If your child is older than 2 years 6 months (30 months) please do not continue this application. Call us at 978-685-0871
Parent/Guardian
First Name (Required)
Middle Name
Last Name (Required)
Birthday (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 (Required)
Opt In for Text Messages
Yes
No
Home Phone (Required)
Work Phone (Required)
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
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Creole
English
Other
Russian
Spanish
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
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
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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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)
Middle Name
Last Name (Required)
Birthday (Required)
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.
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Creole
English
Other
Russian
Spanish
Spanish
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
Provides Financial Support
Yes
No
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
American Sign Language
Creole
English
Other
Russian
Spanish
Spanish
Is another language being acquired or learned at home?
Yes
No
Number in Household
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
WIC ID (if applicable)
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Creole
English
Other
Russian
Spanish
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Insurance Number
Medicaid Number
Doctor/Medical Home (Required)
Andover Pediatrics
Atrius Health-Pediatric Chelmsfo
Boston Children's Hospital
Cardinal Pediatrics
Childhood Lead Poisning Preventi
Children's Health Care
Children's Medical Office
Community Medical Assoc.
Community Optics
Early Head Start
GLFHC - Essex St.
GLFHC - Haverhill St.
GLFHC - Lawrence Gen Hospital
GLFHC - Lawrence High School
GLFHC - Methuen Office
GLFHC - Park St.
GLFHC - Winthrop Ave
Greater Lowell Pediatrics
Haverhill Family Health Center
Lawrence Family Doctors
Lexington Eye Associates
Mass Eye & Ear
Meel Pediatrics
Merrimack Valley YMCA
Methuen Pediatrics
MGH Chelsea Healthcare Center
New England ENT
New England Eye Center
New England Eye Specialist
North Andover Pediatrics
Pediatric Health Care Associates
Pentucket medical
Pentucket Pediatrics- Andover
Pentucket Pediatrics-Haverhill
Rebecca Lambert, MD
South Boston Community Health C.
Steward Medical Group
Steward Primary Care Methuen
Tallman Eye Associates
We Care Pediatrics
Dental Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Dental Coverage Number
Dentist/Dental Home (Required)
488 Essex street lawrence MA
Alis Checovich, DDS
Andover Pediatric Dentistry
Broadway Dental
Children & Family Dent & Braces
Community Dentist
Dental Arts
Dental Bright
Dental Dreams
Dental Partners
Dr. Dental - Methuen
Family Dental Associates
Family Dental Associates
Kangaroo Smiles
Lawrence Dental Center
Lawrence Family Doctors
Lawrence Pediatric Dentistry
Lawrence Pediatric Dentistry
Lowell Comm Hth Ctr Dental Care
Lowell Kangaroo Smiles
Maritza Morell DMD, PC
My Dental-Lawrence
Perfect Dental
Randall L. Davis, D.M.D., P.C.
Small Smiles
Smart Smiles
Smile Studio
Smilebliss Orthodontics
Smiles Dental
The Braces Place
Total Dental
We Care Pediatrics
West Broadway Family Dental
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)
EHS 2024-2025
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
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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 your interest in Early Head Start. Click "Submit" to finalize and send your application. We will contact you when your application has been reviewed. Additional information may be required. *Please note that submitting this application does not guarantee an immediate opening is available.
Required information is missing, see above.