Thank you for your interest in E Center Head Start programs. Please complete the inquiry form below. In approximately one (1) to six (6) weeks, an E Center Head Start Staff will contact you to arrange a meeting to complete an application. At that time, staff will need to verify your family's income and your child’s date of birth.
If you have previously applied to our program please call us at 1-866-417-4255 and let staff know that you would like to re-apply for our program.
If you need assistance, have any questions or need to update your phone number or address, please call us at 1-866-417-4255. Hablamos español! Hablanos si ocupa asistencia para completar una solicitud.
Parent/Guardian
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.
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
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
How did you hear about us
Busqueda de internet/Internet search
Familia o amigos/Family or Friends
Familia que regresa/Returning family
Folleto/Brochure
Otro/Other
Publicidad en línea/Online Advertisment
Radio
Recomendación de un empleado/Employee Referral
Volantes/Flyer
Income from Agriculture?
No
Yes/Si
Address
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
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.
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
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
Family Information
Primary Language at Home
African Languages
American Sign Language
Asian Languages
Caribbean Languages
East Asian Languages
English
European & Slavic Languages
Hmong
Italian
Middle Eastern & South Asian Languages
Native American Languages
Native Centeral American, South American, and Mexican Languages
Native North American/Alaska Native Languages
Other
Pacific Island Languages
Punjabi
Spanish
Unspecified
Number in Family
Gross Annual Income
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
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Child (Applicant)
For Prenatal Application (unborn child), please call 1-866-417-4255.
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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)
2024-25 Head Start
2024-25 Migrant & Seasonal Head Start
2024-25 Migrant Early Head Start
2024-25 Early Head Start
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd 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
Thank you for your interest in the Head Start Program. By clicking the button below you certify that the information you provided is complete and accurate. We will contact you to schedule an application appointment.
Required information is missing, see above.