Welcome to the Blue Water Community Action on-line interest form. We serve St. Clair County children from birth thru age 4. Age eligibility is determined as the age on September 1, 2022 for the 2022-2023 program year. Please complete the form for all members of your family who are eligible. IF YOU HAVE HAD A FAMILY MEMBER ENROLLED IN HEAD START OR EARLY HEAD START WITHIN THE LAST 10 YEARS, PLEASE DO NOT USE THIS ONLINE FORM. Call 982-8541 to apply. If you are pregnant and would like to apply for Early Head Start, please call our main office at 810-982-8541.
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.
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
American Sign Language
Arabic
Cambodian
Chinese
English
Romanian
Sign Language
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)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Unemployed
Unemployed &Training or School
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
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)
Suffix
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
American Sign Language
Arabic
Cambodian
Chinese
English
Romanian
Sign Language
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)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Unemployed
Unemployed &Training or School
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Family Information
Please provide the following information as an estimate to determine eligibility. Proof of income will be required.
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
American Sign Language
Arabic
Cambodian
Chinese
English
Romanian
Sign Language
Spanish
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
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
Child (Applicant)
Please complete an application for all children under the age of 3. Pregnant women and children 0 thru 2 years old are eligible for Early Head Start. (use September 1, 2022 of the program year to determine age)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
SSN
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
American Sign Language
Arabic
Cambodian
Chinese
English
Romanian
Sign Language
Spanish
Doctor/Medical Home
Adair, Dr.
Algonac Family Practice
Alliance Hearing Care
Allison, Dr
Anchor Bay Clinic
Annette Barnes
Ascension Masonic Medical Center
Ascension Medical Group-St. John
Ascension St John OB/GYN Clinic
Bailey, Dr. David
Barker, Dr William
Barnes, Dr.
Batra, Dr.
Bazo, Dr.
Beaumont Family RochesterHills
Beaumont Urgent Care -Lenox
Berry, Dr. Ashraf H.
Best Kids PC
Better Vision Center
Bhargava, Dr.
Bitar, Dr. Mohammad A
Blanchet, Dr.
Blue Water Eye Care
Blue Water OB/GYN
Boutt, Dr Julie
Bozo, Dr.
Burton, Dr. Mary
Butler, Dr.
Caister, Dr. M OD
Camara, Dr.
Carley, Dr. George
Carter, R.
Catalan, Dr.
Catalan, Dr. M
Cavataio, Dr.
Cecil. Dr. Leah
CHC - E China
CHC - Ft Gratiot
CHC - Marysville
CHC - Pt Huron
CHC - Yale
Children's Eye Care
Children's Special Health Care
Childrens Hospital
Chouhury, Dr Aminul
Chung, Dr.
Church, Sage D.O.
Clark. Dr
Colombo, Dr Antonino
Columbo, Dr. J.
Comm. 1st Health Center-NewHaven
Comm. 1st HealthCenter PH Office
Comm. 1st HealthCenter/Algonac
Comprehensive Woman's Care
Cornerstone Lakeview Pediatric
Cruz, Dr.
Crystal Cares -CNA program
Curell, PA Kim
Dalton, Dr Ronald
DeCarlo, Dr. Loren
Deckerville Healthcare Services
Delta Dental
Dev, Dr.
Dharamraj, Dr. Keith
Diehl, Dr.
Dolan, Dr.
Doshi, Dr.
Dowden, Dr.
Dr Carley and Associaties
Dr Michael Plocinik
Dr. A Mowery
Dr. Bailey
Dr. Barry Frocillo
Dreyer, Dr Jamie
Dubina, Dr Elizabeth
Dugan, M.
Dzebo, Ruzica
Early On
Eastman, Dr.
Egbulefu,Dr. Donna
Elder, Dr Badrea
Eye Care Specialists
Fabian Dr
Family First Armada
Foster, Dr Michelle
Fowler, Dr. Sharon
France, Dr. Sonja
Free Online Resources
Garcia, Dr.
Glapinski, Dr. Robert
Gomez, Dr
Gorman, Dr. Stacey
Grace, Dr.
Greater Yale Medical Center
Gross Point Park Opthalmology
Grover, Dr.
Haddad, Dr Fawaz
Hafeez, Dr. Farrah
Hall, Dr.
Hamilton, Dr. Mark
Hamilton, Jo Jean (Mid-Wife)
Harastani, Dr.
Hartman, Dr.
Hayen, Dr.
Hayes, Jeffrey Dr.
Health Department
Heitmann, Dr Ronald
Henry Ford Health
Henry Ford HealthCenter-Fraser
Henry Ford HealthSystem-Plymouth
Henry Ford Macomb
Henry Ford OptimEyes
Hernandez, Dr
HF Lakeside Pediatrics
Hill, Dr Stacey
Hindy, Dr.
Hoda, Qamrul Dr.
Howard, Dr. John
Hunt, Dr.
Huron Family Practice
Hurtivese, Dr.
Hutzel Womens Health Specialists
Ice, Dr. Anne-Mare'
IHA Arbor Park Pediatrics
IHA Medical Gp-Lake Orion
Imlay City Family Practice
Islam, Dr Shamim
J. Fulmer
Jackson, Dr.
James, Dr.
Jerkins. Dr.
Karadimas NPP, Laura
Karmo, Dr. Nibras
Keister, Dr.
Khan, M., Dr.
Kindsvater, Dr. Patricia
King, Dr. Carolan
Kizy, Dr Thomas
Kontos, Dr.
Kresge Eye Institute
Kuhl, Dr Shirlee
Kumar, Dr. Sunil
Kut, Dr.
Kutche, Dr. Blake MD
Lajoie, Dr.
Lake Huron Medical Grp Marysvill
Lakeshore ENT
Lakeview Pediatrics
Lambrecht, Dr.
Laming, Dr.
Lapeer County Vision Center
Lapeer Pediatrics
Lapinski, Dr.
Ledkte, Steven Dr.
Lee-McKay, Dr Carol
Lensmeyer, Dr.
Leo, Dr. Christina
Levernz, Brenda Dr.
Lighthouse Family Medicine
Lounsbury, Angela Dr.
Macomb Health Center
Macomb Pediatric Assoc
Mandy, Dr David
Marwood Nursing & Rehab
Maternal Fetal Medicane Oakland
Matich, Dr.
Matti, Dr.
McCarroll, Dr.
McCowan, Dr. Robert
McGahea, Dr.
McLaren Macomb Pediatrics
McLaren Medical Marysville
McLaren Port Huron
McPhilimy, Dr. Scott
MedEspress Urgent Care
Mercatane, Dr. Annette
Meridian Insurance
Merkler, Dr.
Merkler, Michael. Dr.
Michigan Pediatric ENT Associate
Michigan Pedriatric ENT assoc
Mitchell Medical Center
Moschouris, Dr.
MSU Extension
Mullally, Dr.
Munn, PA. Christina
Nandamudi, Dr.
Nandi, Dr.
Nandi, Dr. Hemalata
Naqvi, Dr
Naughton, Dr Joseph
Nedic, Dr
New Baltimore Pediatrics
New Haven Medical Center
Nimtz, Dr. Jennifer - Macomb
Nimtz, Jennifer D.O.
Niver, Dr.
North Macomb Medical Center
Northeast Michigan Community Ser
Northpointe OB/GYN
Northpointe Pediatrics
Nugent, Dr. Lori
O'Brien, Dr.
O'Halloran, Dr. Philip
O'Mahoney, J
Olson, Dr.
Online Resources
Packey, Dr
Paknikar, Dr. - CHC
Park Peds
Partners in Family Care
Pashley, Dr
Pasia, Dr.
Payton, Dr.
Pediatric Clinic P.C.
Pediatric Healthcare
Pediatric North
Pediatric Ophthalmology Eye Care
People's Clinic
Physician Health Care
Physician HealthCare Network
Physician Healthcare Network-PH
Physicians HealthCare Network-FG
Physicians Healthcare St. Clair
Piontkowski, Dr Timothy
Plumar, Dr. Heather
Point Allergy & Asthma
Pokriefka, Dr. Eileen
Priebe, Dr.
Priska, Dr.
Pullukat, Dr Annamma
Quigley Dr.
Rao, Dr. Sheila
Raymond, Dr. Michele
Redding, Dr
RESA, J. Lee
Rice, Dr Kathryn
Rice, Dr. S.
River District Family Practice
Roarty
Rodrigues, Dr.
Ross Dr.
Rummani-Askar, Dr. Sundus
Ruthven, Dr.
Sams, Dr James
Sanilac Health Dept.
SCCHD
Scheel, Dr. Lisa
Scholey, Dr. Jessica
Scofield, Dr. Barry
Scott, Dr Colleen
Scott, Dr. David
Serajee, Dr. Fatema J
Shelby Pediatrics
Shmina, Dr Kimberly
Shrivastava, Dr. Shilpi
Sidra Sindhu
Silver Pine Medical Group
Singleton, Dr.
Sinia Grace Pediatrics
Smith, Dr Ben
Smolinski, Dr.
Somerville, Dr Paul
Souphis, Dr.
Spisak, Dr
St John River Family Practice
St. Clair County RESA
St. Clair Medical Center
St.Johns pediatric Associates
Stallwood, Dr.
Starbird, Dr. William J.
Stefan, Dr. Vladimir
Stevens, Dr
Stilson ENT
Stratford, Dr.
Stromberg, Dr.
Sturgis, Margaret
Subnani, Dr.
Sue, Dr - River District
Sue, Dr.
Susko, Dr Renee
SVS Vision
Swetech DO, Stephen
Talla, Dr Sarveswarrarao
Tangri, Dr
Teen Health Center
Tender Care Pedatrics
Thibault, Dr.
Thompson, Kimberly Dr.
Thumb Pediatrics
Torres, Dr. L.
Tseng, Peter MD
Vashi, Dr. Sonali
Vempati, Dr.
Vernor Pediatric
Vilas, Dr. Amy
Villanueva, Dr. Ethel
Vladimir, Dr. Stefan
Vondrachek, Dr
Votava, Randi
Vyas, Dr Bhavana
Wadhams Family Care
Weidner, Dr.
Weymouth, Dr.
White, Dr.
WIC
Widner, Dr Tiffney
Wilhelm, Dr. - CHC
Woytta, Dr. O.D.
Yale Family Care
YMCA
Zelenek, Dr.
Zmiejko, Dr.
Dentist/Dental Home
Adams, Dr. Lindsey
Advanced Dental
Algonac Dental
Anchor Bay Dental Associates
Andrews, Dr. Dale G.
Appletree Dental Center
Aspen Dental - Chesterfield
Aspen Dental - Fort Gratiot
Bailey Dental Group
Banner, Dr. Kara
Baribeau, Dr. Douglas
Bass, Dr. Paulette
Bates, Dr. Robert
Batra, Dr. Amit
Batuk, Dr. James
Bay Dentistry
Bay West Family Dental
Beachamp, Dr. Barry
Beck, Dr. Christopher
Birchwood Family Dental
Blue Water Dental Gp.-Marysville
Blue Water Dental Group
Blue Water Family Dentistry
Boyd, Dr. Brian
Bright Smile Dentistry
BrightSide Dental-Shelby
Brion, Dr. Jill
Brookside Dental Center
Carlino, Dr. John P.
Carolan, Dr. Andrew
Carolan, Dr. Kevin
China Twp. Family Dentistry
China Twp. Family Dentistry
Christen, Dr. E.
Cichoracki, Dr. Julie
Coleen DeLacy DDS
Combs, Dr.
Comm. 1st HealthCenter PH Office
Community 1st Dental
Community 1st Dental/PH
Community Dental Clinic
Cornell-Valdes, Dr. Celeste
Dabiri, Dr. Donya
Dental Care of Michigan-Shelby
Destiny Dental
Detroit Dental Specialists
Easton, Dr Jeffrey
Eastpointe
Fadi Abshara, DDS
Fagan, Dr. Susan
Family Dentists
Ferguson, Dr. Scott
Folbe, Ellen DDS
Forbes, Dr. Adrian
Fraser, Dr. James
Friederichs, Dr. George
Gadioli, Peter. Dr.
Garrant, Dr. Scott
Gauss, Dr. Chester
Gaynor Family Dental
Gentle Dental of New Baltimore
Gilbert, Dr. Gary
Gillhooley, Dr. Ralph
Giuliano, Dr. Karla
Goodich, Dr.
Great Expressions Dental Center
Great Lakes Bay Heath Center-ImC
Great Lakes Family Dental Group
Growing Smiles -Richmond
Growing Smiles Chesterfield
Growing Smiles-St Clair Shores
Grudich, Dr. Nicholas
Grunwald, Dr Erica
Gschwind, Dr. Sandra DDS
Guilliat, Dr. Colleen
Gustafson, Dr Kerri
Hazleton, Dr. Thomas
Heck, Dr. Jack C.
Hengehold, Dr. Julie
Higgins, Dr. Mary
Horgan, Dr. Thomas
Huron Dental
Hurst, Dr. Kathleen
Imlay City Dental, PLLC
Jackson, Dr. Kelly
Jundi-Sammon, Dr.
Karmo, Dr. Eva
Kids Smiles Dentist
Kimball Family Dentistry
Klu, Dr. Shelly
Kokkinakis, Dr. Stamatis
Lacy, Dr.
Lakeside Pediatric Dentistry
Lamb, Mark Dr.
Langolf, Dr.
Lapeer City Dental
Lapeer Dental Center
Lapeer Family Dental
Larkin, Dr. Janet
Lazovski, Dr. Lora
Lexington Dental Care
Lomasney, Dr. David
Macomb Children's Dentistry
Magsoudi, Dr. DDS
Main Street Dentristy
Marcuz, Paul
Marine City Dental
Mariner Dental
Martin, Lawrence Dr.
Matthew Healy, DDS
McCormick, Dr. Kenneth
McNaughton Dentistry
Meyer, Dr. Scott
Middleton, Vicki, RDH
Mirabelli, Dr. Maurizo
Misko, Dr. Michael
Monroy, Dr. Phillip
My Community Dental
New baltimore family dentistry
New Haven Family Dentistry
Nichols, Dr. Hank
Noffert, Dr. David
O'Bryan, Dr. Robert
Odgers, Dr. Richard
Parrott, Dr. Jeremy
Parrott, Dr. Sandy(retired)
Pediatric Dentistry -Clinton Twp
Peraino, Dr. Daryl
PGS Dentistry - Romeo
PGS Dentistry Marysville
PGS Family Dentistry
Pleasant Dental
Powell, Dr.
Pradko, Dr.
Quality Dental
Radtke, Dr. Dana
Redwood Dental
Refresh Dental - Macomb County
Richmond Dental Care
Richmond Dental Reflections
Riverside Family Dental
Robbins-Margeas, Dr. Andrea
Rochester Hills Pediactric Dent.
Rosenberry Family Dental
Rossow, Dr. Christopher
Saad, Dr Istine
Sandusky & Lexington Dental Care
Sandusky Family Dentistry
Sanilac Comm. Dental
Sanilac Smile
Sattelberg, Dr. Carl
Schroyer, Dr. Gary
Seaway Dental Group
Shaheen-McNiel, Dr. Jennifer
Shelby Family Dental Care
Simmons, Dr. Mary
Slanec, Dr. Jared
Smile MI -MI Dental Assoc.
Smile Zone/New Era
Smileguys, PLLC
Sobers, Dr. Charles
Solt, Dr Bryan
Sparkle Dental
St. John's Marsh Dental
Sullivan, Dr. Stacy
Taylor's Family Dental
Thompson, Dr. Roger
Tiny Tooth
Tomiuk, Dr. John
Toothworks - Grosse Pointe Woods
Tracht, Dr. Arnold
Tucker, Dr. William
United Health Care
Vinckier, Dr. John
Vinckier, Dr. Mary
Vinckier-Kersten, Dr Elizabeth
Vrebenburg, Dr. Michelle
Wajeeh, Dr. Omar
Wang, Dr
Ward, Dr. James
Water's Edge Dentistry
Weiner, Dr Samuel
Wendela, Dr.
Yale Dental Center
Yax, Dr. Gerald
Young, Dr. Robert
Zemens, Dr. Lisa
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)
Early Head Start 2022-2023
Serving pregnant women and children 0 to 3. Center-based and home-based options available
Head Start 2022-2023
Free Preschool for Children Ages 3 to 5
1st Location Preference
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2nd Location Preference
<p></p>
- 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 the Head Start/Early Head Start/GSRP programs. THIS IS NOT A COMPLETE APPLICATION. Income and additional information is needed before your child can be put on the waitlist. Once you hit submit, further instructions will be sent to the email address provided. Please hit submit when finished with your form.
Required information is missing, see above.