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Early Head Start serves children up to the age of 3 years old and pregnant women. Please complete each field below entirely if you are interested in applying for Early Head Start. Please only complete for children that are already born, otherwise, the pregnant mother should apply as the applicant. If you have a child that is age 3 or older, they are ineligible for our services and may be eligible for Head Start. If you live in Grant County, contact Marion Community Schools Little Giants at 765-651-2080. If you live in Blackford County, contact Community Development Institute Northeast at 260-413-6277.

Fill out the information below for the "primary adult" in the family who has custody of the child applying for services. If you aren't sure how to answer a question, leave it blank and EHS will complete with you at the Intake appointment.

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

Fill out the below information for where you are currently living. If you are experiencing homelessness, fill out an address where you are able to receive mail. If you aren't sure how to answer a question, leave it blank and EHS will complete with you at the Intake appointment.

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

Fill out the information below for the "secondary adult" in the family who has custody of the child applying for services. This adult must be living with the family to be included in the application. If you aren't sure how to answer a question, leave it blank and EHS will complete with you at the Intake appointment.

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

Please tell us about your family income and resources. If you aren't sure how to answer a question, leave it blank and EHS will complete with you at the Intake appointment.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

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?

Fill out the information below for the child applying for services. This child must be already born and under the age of 3 years to be served by Early Head Start. If you aren't sure how to answer a question, leave it blank and EHS will complete with you at the Intake appointment.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

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 Early Head Start. Make sure to click submit to finalize your Pre-Application. A staff member will be in contact with you shortly to set up an intake appointment.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings