Apply Online

Please call 401-367-2001 or email at headstartenrollmentinfo@ebcap.org if you are not able to complete this on-line application. East Bay Community Action Program serves all eligible residents, regardless of their gender, age, race, or income status.

Please complete the following for the primary adult.

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

Other Language

Highest Grade Completed

Child's Relationship

Custody

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

Is there another parent or guardian living in the same household? If so, please complete the following for the secondary adult.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

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

Other Language

Other Language Proficiency

Highest Grade Completed

Child's Relationship

Custody

In order to determine if your family's income is at or below the Federal Income Poverty Guidelines, we must know how many individuals are living in your household who are (1) supported by the income of the parent(s) or guardian(s) of the child enrolling in the program and (2) related to the parent(s) or guardian(s) by blood, marriage or adoption, and/or (3) the child's authorized caregiver or legally responsible party. In the section, "Number in Family" please use this definition.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Household

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)?

Please complete this section for the first child you wish to enroll. If you are pregnant and applying for yourself, please re-enter your information.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Race

Hispanic

Other Language

Other Language Proficiency

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

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings