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Every Child Deserves a Head Start!

Thank you for your interest in YMCA Early Childhood Impact (ECI) programs. We provide free, high-quality early learning services to eligible families. These services are funded through federal and state contracts with Office of Head Start, California Department of Social Services and the California Department of Education.

Our programs serve families with children ages birth to 5. We embrace diversity and welcome children of all abilities.

Cost:
The majority of families enrolled in our programs do not have a family fee.

Applying for Services:
The first step in applying for services is completing the Pre-Enrollment Application, located below. Enrollment priority is based on family size, family income, and other factors. Enrollment criteria determines which families have the highest priority for placement. Please complete the application thoroughly so that we can best understand your family circumstances.

Documentation:
Please provide as much supporting documentation as possible. Documentation can be uploaded to this application.

Examples of supporting documentation:
- Proof of address. Utility bill or lease.
- Birth records. For ALL children in the family.
- Proof of family income for the prior year. This can include tax returns and W2s, check stubs, unemployment, child support, etc.
- Proof of public assistance. This includes Cal-WORKS, Cal-Fresh or SSI.

For the child applying for services, we will need:
- Current immunization records.
- IEP/IFSP if they have one.

Our agency will contact you if your application is incomplete or if additional documents are needed. If you have questions or need support, please email enroll@ymcaeastbay.org or call our toll-free number 844-247-2385.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

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

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

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

A family is require to report the secondary parent regardless of marital status if 1. the secondary parent resides in the household or 2. custody of the enrolling child is shared.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

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

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

Are there other adults in the household?

Add Another Adult

Number in Household: consist of members who live in the same house that may or may not be related. (grandparents, uncles, aunts)

Number in Family: Should only include persons living in the household who are supported by the income of applicant child's parent or guardian and related to the parent by blood, marriage or adoption.

Gross Annual Income: All monies received is considered countable. Total gross annual income should include all adults over 18 years old that is part of the family size.

Temporary Assistance for Needy Families (TANF): also known as CalWorks or Cash Aid, Cal-Fresh or Food Stamps.

Supplemental Security Income (SSI): Only the program to assist low-income individuals, including those who are disabled, blind or 65 and over. Does not include disability insurance payments and survivor benefits.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home (Required)

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income (Required)

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program? (Required)

Is your family receiving Supplemental Security Income (SSI)? (Required)

Is your family receiving services from WIC?

WIC ID (if applicable)

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps? (Required)

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?

Add Emergency Contact

If your child has special needs, diagnosed disability or has an Individualized Family Service Plan (IFSP) or an Individualized Education Plan (IEP), please indicate it in the comments section below. If you were referred to our program, please indicate in the comments section and include who referred you.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

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?

How did you hear about HS

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

By clicking submit, I certify information contained in this application is true and correct to the best of my knowledge. No false or misleading statements have been made. The acceptance of this application does NOT guarantee services or placement. Further, I authorize the YMCA to share information with HS/EHS partners to support enrollment.

On the next page, the first screen of the document upload page will appear. If you're unable to upload documents at this time, please continue to fill out all the fields requested and finish the submission without attaching any document.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings