Please fill out all fields. If one of your children has attended a Head Start or Great Start Readiness Program in the past or you receive a duplicate message, please all us at 734-994-8100 extension 1551. This means that you are already in our database system and we can update your records.
Parent/Guardian
The Primary Adult is the Parent/Guardian who lives in the home.
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
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Language
American Sign Language
Arabic
East Asian Language
English
European / Slavic
French
Somali
Spanish
West Asian/Indian Language
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 or Higher
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
Provides Financial Support
Yes
No
Estimated Income
Address
Head Start and Great Start Readiness Programs defines homeless as living in a shelter, motel, hotel, campground, vehicle, or in a residence that is not fixed, regular or adequate.
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 include only if second parent/guardian lives in the home.
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
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Language
American Sign Language
Arabic
East Asian Language
English
European / Slavic
French
Somali
Spanish
West Asian/Indian Language
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 or Higher
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
Provides Financial Support
Yes
No
Family Information
Please answer all questions in this section.
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 Language
American Sign Language
Arabic
East Asian Language
English
European / Slavic
French
Somali
Spanish
West Asian/Indian Language
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 list the child that you are enrolling in one of our programs.
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Language
American Sign Language
Arabic
East Asian Language
English
European / Slavic
French
Somali
Spanish
West Asian/Indian Language
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Medicaid
No Insurance
Private Health Insurance
Other Coverage
Medicaid
No Insurance
Private Health Insurance
Insurance Number
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Medicaid Number
Doctor/Medical Home
Alsan Medical Clinic
Ann Arbor Family Care PLLC
Balinski, Allen MD
Beaumont Dearborn Pediatrics
Beaumont Pediatrics-Canton
Belleville Health Care P.C.
Belleville Pediatrics
Bernhard, Clint Dr.
Brentwood Pediatric Assoc.
Brighton Pediatrics, P.C.
Brooks Lyon & Brooks DO PC
Canton Center Pediatrics
Canton Pediatrics
Care 4 You Pediatrics
Care Pediatrics
Caritas Ctr for Women's Health
Cedar Community Health Center
Center for Family Health
Chase Pediatrics
Cherry Hill Village Family Med
Children's Hospital of Michigan
Children's Speciality Center
Collins, James MD
Compean Family Medicine PLLC
Corewell Health Care Center
Corewell Health Family Medicine
Corner Health Center
Dabbagh, Maha MD
Dearborn Peds & Adolescent
Detroit Community Health Connect
DHHS-MiBridges Navigation
Diverno, Joel MD
Downriver Pediatric Associates
Dundee Pediatrics
Emmaus Health
Family Medical Center
Fenton Family Medicine
Galas, James MD
Ghuznavi, Sultana R. MD
Great Lakes Pediatric Associates
Green Tree Pediatrics
Hamilton Community Health Networ
Hartland Pediatrics
Hashikawa, Andrew MD
Health Specialists of Lenawee
Healthy Neighborhoods
Henry Ford Med Ctr - Hamtramck
Henry Ford Med Ctr - Plymouth
Henry Ford Med Ctr - W Bloom
Henry Ford Med Ctr.-Dearborn
Henry Ford Medical - AA
Henry Ford Medical - Canton
Henry Ford Medical - Dearborn
Henry Ford Peds - Sterling Hts
Highland Park Health Center
Hollywood Pediatrics
Hope Dental Clinic
Hope Medical Clinic -Ypsi
IHA - Arbor Park
IHA - Brighton Family Care
IHA - Canton Family Medicine
IHA - Canton Peds Heritage Park
IHA - Chelsea Pediatrics
IHA - Child Health Plymouth
IHA - Clinton Family Practice
IHA - Domino's Farms
IHA - Internal Med-Livingston
IHA - Livingston Pediatrics
IHA - Milan -Fam & Internal Med.
IHA - Pediatrics - Arbor Park
IHA - Pediatrics Canton
IHA - Urgent Care - Livingston
IHA - West Arbor
IHA OB/GYN Brighton
IHA Primary Care Livonia
IHA-Child Health-West Arbor
IHA/St. Jo-Neighborhood Fam Hea
Infantsee
Infinity Primary Care - Canton
Infinity Primary Care - Livonia
Integrative Healthcare Providers
Joyful Pediatrics
Karmo Pediatric Center
Kellogg Eye Center
Khan, Azmathullah MD
Khan, Bader F, MD
Khatib, Basel MD
Kid Kare Pediatrics
Liberty Pediatrics
Licata, Julia
Liv.Co. Dept.of Pub. Health
Livingston Pediatric Center
Livonia Health Center
Madani Mayura, MD
Mandy McClain
McClain, Mandy
McFord Pediatrics
Medical Center Pediatrics
Mercy Christian Health
Michigan Otolaryngology Surgery
MiDHHS
Mo Pediatric Center
Moore Pediatrics & Associates
MSU Health Care Pediatrics
Nasser, Ali MD
Neu Urgent Care
New Horizon Pediatric Care
Northpointe Pediatrics
Oakwood - Westland
Oakwood Health Ctr - Belleville
Packard Health Main
Packard Health West
Packard Health-Ypsilanti
Park Medical Center
Pediatric & Adolescent Ctr
Pediatric Assoc of Livingston
Pediatric Associates of Dearborn
Pediatric Care of Lansing
Planned Parenthood
Premier Pediatrics
Promedica - Adrian
Providence Med Ctr-South Lyon
Providence Park Pediatrics
RAHS - School Based Health Ctr
Regal Pediatrics
S. G. Pediatrics
Sarveswararao Talla
Schuh, Cathy OTR
Serenity Pediatrics
Singh, Yuktanand A. MD
Southeast Michigan Doula Project
Southfield Pediatric Physicians
Speegle, Linda MD
St Joseph - Saline Urgent Care
St. John's Providence-Asencion
St. Joseph Mercy Urgent Care
Sunny Pediatrics
SVS Vision Optical Centers-AA
Tecumseh Family Practice
The Pediatric Center Of Adrian
Trinity Health Pediatrics - Scho
Turke & Thomashow Pediatrics
UM Allergy Clinic
UM Ann Arbor - Peds Neurology
UM Briarwood Family Medicine
UM Briarwood Pediatrics
UM Brighton Health Center
UM Canton Health Center
UM Chelsea Health Clinic
UM Dexter Health Center
UM Domino's Farms
UM East Ann Arbor Health
UM Howell Pediatrics
UM Northville
UM Nursing Students
UM Ophthalmology Clinic
UM Otolaryngology Audiology
UM Pediatrics at E Ann Arbor
UM Pediatrics Resident Prog.
UM Peds Oncology/hematology
UM Saline Health Center
UM Von Voigtlander Women's Hosp
UM West Ann Arbor Health Ctr
UM Ypsilanti Health Center
Union Lake Pediatrics
University Pediatrics
Vinay K Duggal Inc
Washtenaw Co. Public Health
Washtenaw Health Plan
Washtenaw Medicine of Saline
Wayne Pediatrics
WCPH
Wellness Pediatrics
Wellness Plan Gateway Med Ctr
Western Wayne Fam Health Ctr
Western Wayne Physicians
Westland Pediatrics
WIC
WISD Early On
Women, Infants, & Children (WIC)
Woodhaven Pediatrics
YCS School Nurses
Yoo, Jin Woo, MD
Ypsilanti Urgent Care
Dental Coverage
Medicaid
No Insurance
Private Health Insurance
Dental Coverage Number
Dentist/Dental Home
A+ Dentistry
Abbass, Razan DDS
Accurate Dental
Adiska Family Dental
Adrian Dental
Adrian Family Dentistry
Affordable Family Dentistry
All About Smiles
All Smile Dentristry
All Smiles-By Dr. Phil
Amazing Dental
Ann Arbor Family Dentistry
Ann Arbor Pediatric Dentistry
Ann Arbor Smiles Huron Pkwy
Ann Arbor Smiles Pediatric Golf
Ann Arbor Smiles West Stadium
Ann Arbor's Dentist
Arbor Dental
Arbor Lodge
Arbor West Dental Center
Arnett Family Dentistry
Art of Dental Westland
Aspen Dental
Atwan, Salwa DDS
Barber, Chad DDS
Beacon Dental
Benham, Kent Dr.
Berg, James DDS
Beydoun And Associates Dental
Bhakta, Sujata DDS
Bloomfield Children's Dentistry
Blossom Pediatric Dentistry
Breasbois, Ryan DDS
Bright Side Dental
Bright Side Dental
Brighton Dental
Brighton Healthy Smiles
Broad Street Dental
Canton Center Dental
Canton Dentists
Canton Family Dentistry
Canton Pediatric Dentistry
Canton-Plymouth Family Dentistry
Care Family Dental
Cavalier Family Dental
Center for Family Health
Chelsea Family Dentistry
Children's Dental Care Dearborn
Children's Dental Care of Canton
Choice Dental
Clear View Dental
Cocco, Dina DDS
Cole, Douglas DDS
Comfort Smiles of Ann Arbor
Community Dental Center
Comprehensive Dentistry
Contemporary Dentistry
Cox, David DDS
Cranston Family Dental
Daily Dental Center PLLC
Dearborn Dental Group
Dearborn Family Dentistry
Dearborn Family Smiles
Deliver Dental Solutions, Inc
Dental Dreams Lansing
Dental Dreams Ypsilanti
Dental House
Dental Works
Dentistry By Design Dr. Li He
Dentistry For The Entire Family
Dentists R US
Destiny Dental Taylor
Dexter Dental Center
Dexter Dental Studio
Dexter Family Dentistry
Dexter Pediatric Dentistry
Distinctive Dental Smiles
Elan Dental Group
Enhance Family Dentistry
Enspire Dental
Ernst, Richard DDS
Everwell Dentistry
Excel Dental
Executive Dentistry
Family Dentistry of Belleville
Feller, Todd DDS
Finazzo, Jody DDS
Flint Family Dentistry
Fluoride Varnish Team
Fowlerville Dental Care
Gateway Dental Care
Gentle Dental Associates
Gentle Dental Westland
Gentle Family Dentistry S Lyon
Gerigk, Carola DDS
Gochanour, G. Gary DDS
Golnick Pediatric Dental Taylor
Grace Dental Care
Grand River Family Dentistry
Grant, Marnie DDS
Greashaber Dentistry
Great Expressions - Ann Arbor
Great Expressions - Brighton
Great Expressions - Canton
Great Expressions - Westland
Great Expressions - Ypsilanti
Great Lakes Family Dental Dexter
Great Lakes Family Dental Saline
Hamburg Family Dental
Hammoud Family Dental
Hamtramck Dental Center
Hartland Dental Care
Healthy Smile Family Dent-Canton
Healthy Smile Family Dent-Ypsi
Healthy Smiles Dental Care
Henke, Natalie DDS
Hern Family Dental
Herrero, Alberto DDS
Heys Dental
Hider Family Dentistry
Highland Family Dentistry
Hoffman, Robert DDS
Hope Dental Clinic
Huron Dental Associates
Huron Dentistry
Jackson Pediatric Dentistry
JC Dental Clinic
Karey, Kimberlee J. DDS
Khan, Farah DDS
Kim, Young S DDS
LaBreck Dentistry
Lake Pediatric Dentistry
Lakeview Dental Care
LaRock Dental
Laurich Dentistry
Lee Center Dentistry
Lee, Julie DDS
Liberty Dental PLC
Lifetime Dental S Lyon
Lifetime Dental-Canton
Lucas-Perry Dental Group
Maize And Blue Dental
Margenau, Roy DDS
Marogy, Sundus DDS
Mayday, Brian DDS
Mi Smile Family Dental
Milan Dental Associates
Morrison, John E. DDS
My Community Dental Center Howel
My Community Dental Center Ypsi
New Era Dental
Noonan, Brian DDS
Norman-Kotre, Shannon DDS
Oak Valley Dental Associates
Oakman Family Dentistry
Packard Family Dentistry
Pandya Family Dentistry
Patel, Bonnie P, DDS
Pear Tree Dental
Pediatric Dentistry Of Brighton
Personal Touch Dentistry
Polisuk, Steven DDS
Pomerance Integrative Dental
Portable Smiles Mobile Dentist
Powell And Udrys Dentistry
Price, Christopher DDS
Progressive Dental
Pullen, Kyle DDS
Purpose Dental
Restauri, Donald DDS
Rice, Kimberly A. DDS
River Oaks Dental
Saad Smiles
Sai Family Dentistry
Saline Dental Care
Saline Family Dentistry
Sandberg, Mary Jo DDS
Schaub, Matthew L. DDS
Schmidt, David, DDS
Schmidt, Kevin J. DDS
Schmude, Charles DDS
Shortt Dental
Siddiqui, Fawzia A. DDS
Simply Dentistry
Singleton, Michael DDS
Smile Here Family Dental
Smile Programs-Mobile Dentist
Smiles for a Lifetime-FV-PA161
Smiles of Grand River
Sobh, Ali A. DDS
South Huron Dentistry
South Lyon Dental Care Center
South Lyon Dental Group
Sterling Dental Group
Sterner Family Dental
Stevenson, Robert J. DDS
Stowers, Megan DDS
Sunrise Dental - South Lyon
Taylor Smiles
The Dental Spa
The Graceful Smile Dental
The Lakes Dental Care
Thrive Dentistry
Today's Orthodontics
Toomajanian, Laurie J. DDS
Tooth Town Pediatric Dentistry
Toothworks
Total Smiles Dental Group
Tower Dental
Tree Town Pediatric Dentistry
UM School Of Dentistry
United Dental Center
Van Alstine Family Dentistry
Van Dyke Dental
Village Family Dental
Walcott Dental
Washtenaw Dental
Watson, James A. DDS
WCCC Dental Clinic
Wennersten, Donald DDS
West Ann Arbor Dentistry
Western Wayne Fam Health Ctr
Westfall, Alizia DDS
Westgate Dental
White Pearl Dentistry
White Pine Dental Health
Whittaker Road Dental
Wolverine Family Dentistry
Woodland Lake Family Dental
Wurtzel Family Dentistry
Ypsi Arbor Family Dentistry
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)
EHS 2024-2025
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
Siblings
Are there other children in the family?
Add a Sibling
I certify that this information is true. I understand that the information in this application will be held in strict confidence with the agency with the exception of other preschool programs for the purpose of coordination of services, and is accessible to me during normal business hours. Early Head Start of Washtenaw County will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, handicap or political beliefs. Thank you for completing the application for Early Head Start. A program staff member will contact you within 10 business days to continue processing your application.
Required information is missing, see above.