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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. 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 and Family Services at 260-726-9318.

Fill out the information below for the "primary adult" in the family who has custody of the child applying for services.

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.

English Proficiency

Other Language

Other Language Proficiency

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.

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.

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.

English Proficiency

Other Language

Other Language Proficiency

Employment Status

Child's Relationship

Fill out the information below for the child applying for services. This child must be under the age of 3 years to be served by Early Head Start.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

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)

1st Location Preference

2nd 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 contact sheet. 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

Child (Applicant)

Location Preferences

Additional Applicant

Siblings