Apply Online

We are so excited that you are interested in our Early Head Start Program. There are so many great benefits that may be available to you and your children!
Complete the application below to get started. All information provided is confidential and will only be used to determine eligibility and program options for Early Head Start Services.
If you are unable to complete the application online give us a call at 719-275-0550 to set up a time to complete it in person with our Enrollment specialist.
We look forward to working with you and your family!

Please enter in information for the Primary Adult in the home. This is the adult that will be the primary contact for Early Head Start enrollment.

First Name (Required)

Middle Name (Required)

Last Name (Required)

Nickname

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 (Required)

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Please click on the drop down boxes to provide your address.
Please note that "experiencing homelessness" can include the following:
Sharing housing with others due to economic hardship or loss of housing
Living in motels, hotels, trailer parks, or campgrounds
Living in emergency or transitional shelters
Sleeping in places that are not suitable for human habitation, such as park benches
Living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings

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

Please fill in this section if you are married, and the biological parent lives in the household.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name (Required)

Last Name (Required)

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 (Required)

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Are there other adults in the household?

Add Another Adult

Please complete this section by using the drop down boxes to identify your answers.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home? (Required)

Number in Household (Required)

Number in Family (Required)

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? (Required)

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? (Required)

Is at least one parent/guardian a veteran of the United States military? (Required)

Add Emergency Contact

Please complete this section to identify children who are seeking enrollment into the Early Head Start program by using the drop down boxes to identify your answers.

First Name (Required)

Middle Name (Required)

Last Name (Required)

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language (Required)

Primary Health Coverage (Required)

Other Coverage (Required)

Medicaid Eligibility (Required)

Medicaid Number

Doctor/Medical Home (Required)

Dental Coverage (Required)

Dental Coverage Number (Required)

Dentist/Dental Home (Required)

Does your child have a disability or do you have any concerns about your child's development? (Required)

Is there anything else you want to tell us about your child?

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

After we receive your Early Head Start application, it will be processed and scored based on your child's age, family identified stressors and your family income. An Early Head Start Enrollment specialist will reach out to you for the additional paperwork that is needed to determine eligibility for the program.

We will need a copy of your child’s birth certificate or hospital record of birth and proof of family income for enrollment.

Completed Early Head Start application packets can also be e-mailed to childrenservices@starpointco.com or mailed or hand delivered to Starpoint's SPIN Early Childhood Education Center at 1339 Elm Avenue, Canon City, CO.

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