**For NEW families only. Returning families please call the center for an appointment.** Thank you for your interest in the Delaware County Intermediate Unit’s Early Head Start program! Please enter all information accurately and to the best of your knowledge on the subsequent pages. The information you will need to complete the online registration is: - Name and birth date of every person in the house. - Address and phone number. - Email address for primary adult, and if applicable, secondary adult. - Health Insurance card for insurance numbers. - Name and phone number for doctor and dentist. Please have this information with you to complete the online application. If there is a particular site you would like your child to attend, you will have the option to specify which site you prefer. You MUST complete the application at one time. Once you have completed and submitted your application, a confirmation email will be sent to the email address you provided. If you do not have an email address, you will need to create one prior to continuing.

Parent/Guardian

Address

Click here to find a provider in your area.

Additional Parent/Guardian

Family Information

Please enter all of the information below accurately. The following are some helpful hints when completing this information: Parental Status: - Single Parent – if only one of the child’s parents live in the house - Two Parent – if both of the child’s parents live in the same house - Grandparent – if grandparent(s) have guardianship/custody of child All other information is completed with drop-down answers.

Emergency Contacts

Child (Applicant)

Please enter all required information. The child you are registering for Early Head Start is considered the Applicant. The medical coverage information will be located on the child’s health insurance card.

Location Preferences
- 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
Please check your email for a confirmation of your application submission. Your application will be forwarded to the appropriate staff and you will hear from us shortly to set an appointment to bring required documents. To further prepare for your appointment, please gather the following documents. These documents will be required to complete your registration. Without the following, your registration will be considered incomplete. The required documents are: - Birth certificates for all children in the house. - Proof of income. (If paid bi-weekly, you need to bring two (2) consecutive paystubs. If paid weekly, you need to bring four (4) consecutive paystubs. You can also bring your W-2, 1040 or 1090 from the previous year. If you receive public assistance, child support, SSI or are applying for a foster child, please bring the print-out indicating the amount you receive monthly) - Physical – must be current within one year. - Up-to-date immunization records (shot records). - Dental – must be current within six months. - Health Insurance card. - Allergy forms (If your child has any allergies, please make sure to bring completed allergy forms to your appointment). - Picture ID for all adults in the house. - Recent utility bill. - WIC ID (If you are receiving WIC services). - CCIS letter or waitlist letter (if receiving CCIS). Again, we look forward to working with your family! Thank you for partnering with us!
Required information is missing, see above.