Apply Online

If you have submitted an application in the past, stop here and contact the center of your choice by phone.

If not, please complete the application below. Once you have completed this information, you will need to contact the center of your choice to schedule and interview appointment with a Family Services Advocate. Any supporting documentation (i.e. Birth Certificate, Parent/Guardian State Identification, Tax Forms, TANF, Child Support, SSI, and Child Medicaid/Insurance Card) will be collected at time of interview.

Please note the application process is not complete until an application interview has taken place and all required documents have been received.

Parent/Guardian

The individual entered as the Primary Adult should be the legal guardian or foster parent with proof of custody.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

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

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Teen Parent

Address

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

Additional Parent/Guardian

This individual should be related to the Primary Adult by blood, marriage or adoption.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

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

Teen Parent

Other Adults

Are there other adults in the household?
Add Another Adult

Family Information

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

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)?

Is your family receiving services from WIC?

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

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?

Emergency Contacts

Add Emergency Contact

Child (Applicant)

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

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?

Location Preferences

Which program are you applying for? (Required)

Early Head Start

Ages 0-3

Head Start

Ages 3-5

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.

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 CSP Head Start/Early Head Start. Please click submit to finalize your application. Don't forget to call the center of your choice to schedule an application interview with a Family Services Advocate.

Required information is missing, see above.