Thank you for choosing Early Head Start in partnership with Community Day Care 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 9 months (33 months) please do not continue this application.
Parent/Guardian
First Name (Required)
Middle Name
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 (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.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Creole
English
Russian
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
Lives with Family
Yes
No
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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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)
Middle Name
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
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Creole
English
Russian
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
Lives with Family
Yes
No
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
Russian
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)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Creole
English
Russian
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
Boston Children's Hospital
Childhood Lead Poisning Preventi
Children's Health Care
Children's Medical Office
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
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
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 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
Smile Studio
Smiles Dental
The Braces Place
Total Dental
We Care Pediatrics
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)
Early Head Start Program Year 2023-2024
Early Head Start Program for Children 0 - 3 years
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
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.