Thank you for your interest in our Early Childhood programs. The Campagna Center offers free and low cost comprehensive early childhood/preschool programs that serve children birth to five years and pregnant mothers. Our free programs require that parents meet income eligibility guidelines as determine by state and federal agencies including the Office of Head Start and the Virginia Preschool Initiative funded by the Virginia Department of Education. Families who do not qualify for free programs are encouraged to consider our Campagna Early Learning Center at St. James. Child Care subsidy assistance is available if parents meet certain income and employment/education requirements.
Parent/Guardian
Please complete this section in its entirety with the information of the parent who is completing the application. Make sure you answer all of the questions to avoid delaying the completion of your application.
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
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
African (Amharic, Sahili, Wolof)
American Sign Language
East Asian (Chinese Vietnamese, Tagalog)
English
European & Slavic (German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
M. Eastern/S. Asian (Arabic, Dari, Hebrew, Hindi, Urdu, Bengali,)
Native Central American, South American, and Mexican Languages (Mixteco, Quichean)
Native North American/Alaska Native Languages
Other Language (please specify so we can better accommodate you)
Pacific Island Languages (Palauan, Fijian)
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)
In School
Job Training
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
If Teen Parent, Subsidized?
Yes
No
Address
Please enter your complete address with apartment number if applicable.
Is your family experiencing homelessness?
Yes
No
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
Additional Parent/Guardian
Please complete this section in it entirety with the information of the second parent living in the home or also has custody of the child. Make sure you answer all of the questions to avoid delaying the completion of your application.
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
African (Amharic, Sahili, Wolof)
American Sign Language
East Asian (Chinese Vietnamese, Tagalog)
English
European & Slavic (German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
M. Eastern/S. Asian (Arabic, Dari, Hebrew, Hindi, Urdu, Bengali,)
Native Central American, South American, and Mexican Languages (Mixteco, Quichean)
Native North American/Alaska Native Languages
Other Language (please specify so we can better accommodate you)
Pacific Island Languages (Palauan, Fijian)
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)
In School
Job Training
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
If Teen Parent, Subsidized?
Yes
No
Family Information
Please complete all questions in this section to avoid delaying the completion of your application.
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
African (Amharic, Sahili, Wolof)
American Sign Language
East Asian (Chinese Vietnamese, Tagalog)
English
European & Slavic (German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
M. Eastern/S. Asian (Arabic, Dari, Hebrew, Hindi, Urdu, Bengali,)
Native Central American, South American, and Mexican Languages (Mixteco, Quichean)
Native North American/Alaska Native Languages
Other Language (please specify so we can better accommodate you)
Pacific Island Languages (Palauan, Fijian)
Spanish
Is another language being acquired or learned at home?
Yes
No
Number in Household
Number in Family
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)
Please complete this section with information about the child you are registering. Make sure you answer all questions to avoid delaying your application. If your child has an IEP through Child Find or an IFSP through PIE, please indicate that in the section where it is asked "Is there anything else you would like to tell us about your child?".
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
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
African (Amharic, Sahili, Wolof)
American Sign Language
East Asian (Chinese Vietnamese, Tagalog)
English
European & Slavic (German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
M. Eastern/S. Asian (Arabic, Dari, Hebrew, Hindi, Urdu, Bengali,)
Native Central American, South American, and Mexican Languages (Mixteco, Quichean)
Native North American/Alaska Native Languages
Other Language (please specify so we can better accommodate you)
Pacific Island Languages (Palauan, Fijian)
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
Other Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Insurance Number
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Medicaid Number
Doctor/Medical Home
AAA Pediatrics
Alexandria Health Dept.
Alexandria Medical Center
All Pediatrics-N. Beauregard
American Kids Care, PC
Annandale Pediatrics
Belizaire, MD Renette FAAP
Brandon Ave. Pediatrics
Capital Area Pediatrics-SH
Cheema, Abdussalam MD-Annandale
Children's National Medical Ctr
Childrens Medical Assoc. of NV
Cruz, Carlos MD
Department of Pediatrics
Franconia Pediatrics Assoc.
George Mason Nursing School
Georgetown School of Nursing
Hispanic Amer. Ped. Assoc.-Duke
Hispanic American Pediatric Asso
Howard University Hospital
INOVA Cares Clinic For Children
INOVA Emergency Room-HealthPlex
Inova Health Systems-Alexandria
INOVA-Carlin Springs Rd.
Kaiser Perm - Falls Church
Kaiser Permanente
Kaiser Permanente Reston Medical
Kaiser Permanente-Loisdale Ct.
Kaiser Permanente-N. Washington
Kaiser Permanente-Westpark Dr.
Kharbanda MD, Monica
Maryland Children Health Center
Metropolitan Pediatrics
My Kid's Pediatrics & Adolescent
Neighborhood Health-Glebe Rd.
Neighborhood Health-Howard St.
Neighborhood Health-Richmond Hwy
Neighborhood Health-Sherwood Hal
Northern Virginia Medical Assoc.
NOVA Kids First
NYU Langone Slope Pediatrics
Pediatric Assoc. Of Alexandria
Pediatric Health. Assoc-LaPlata
Pediatrics Associates of Springf
Pediatrics Internationals
Pediatrics of Seven Corners
Prince William Pediatrics
Rodriguez, Gloti, MD
Saad, Al-Hariri MD
Sabastian, Melina MD
Sacoto Pediatrics
Sebastian, Melinda MD
Talib MD, Sawson
The Pediatric Group
TPG Pediatrics
Trent MD, Jocelyn
Unity Healthcare
Van Dorn Pediatrics
West End 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
Advanced Dental Care
Advantage Dental Care
Alex. Children's Dent-E. Monroe
Alex. Children's Dent-Lit River
Alexandria Dental Care Center
Alexandria Dental Smiles
Alexandria Health Dept.
Alexandria Kids Dentistry
Alexandria Pediatric Dentistry
Alexandria Smiles Dentistry-Dawe
AMC Dental
Anwar Ahmad Dentistry
Arlington Pediatric Dentistry
Bhullar DDS, Rajinder
Bradlee Dental Care
Brookefield Dental Associate
Caring Dental-Castle Pl.
Caring Dental-S. Picket
Chantilly Pediat and Fam Dentist
Children Dentristry of Arlington
Complete Dental and Fastbraces
Dentistry for Children of No. VA
Duke Street Dental
Falls Church Pediatric Dental Ce
Graceful Smiles Dentistry
Howard University Hospital
Jeffrey S. Akerman & Assoc.
Kidz Dental and Ortho-Woodbridge
Kool Smiles - Falls Church
Landmark Family Dental
Let's Smile Dental
Little River Dental
McDonald, DDS Anne
MIRA Dental Care
Neighborhood Health Dental
Neighborhood Health-Duke St.
Neighborhood Health-Richmond Hwy
Parker Gray Pediatric Dental Car
Pediatric Dental Care
Pine Dentistry
Potomac Pediatric Dentistry
Renova Smiles
Shiny Dental
Smile Dental Clinic-Falls Church
Smile Experts Dental
Smileville
Springfield Healthy Smile
Super Kids Dental
Today's Dental@Alexandria
Tooth Town of Vienna
Unity Healthcare
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)
Virginia Preschool Initiative 2021-2022
Free Preschool for Children 4 Years Old by 9/30 of the School Year
Head Start 2021-2022
Free Preschool for Children ages 3 to 5
Early Head Start 2021-2022
Free Preschool for Children Ages 0-3 and Pregnant Moms
Family Child Care Partnership 2021-2022
Free Preschool in a Family Child Care Setting for Children Ages 0 to 4
Early Learning Center 2021-2022
Full Day Preschool for Children Ages 3 to 5
1st Location Preference
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2nd 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 our Early Childhood Programs. Please hit submit. The next screen will allow you to upload the required documents to complete your application. You will need to scroll down to see the instructions.
Required information is missing, see above.