Online Application Instructions: Fill out all required fields (those with that say "Required"). Fill out as much as possible the optional fields (the more information we have the better our ability to serve you). Make sure to hit the submit button at the end of the application. By submitting this application online you are certifying that the information given on this application is correct to the best of your knowledge.
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Please fill out the following information on the child you wish to enroll with us. Please note that Medicaid means MaineCare.

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Effective September 1, 2021, by Maine State Law all children must be up-to-date on immunizations before enrolling in an Early Childhood Education/Child Care Setting. We must have a current copy of your child's immunization record before we are allowed to continue with the enrollment process. You can email a copy of the immunization record to Jesse at jwestman@penquis.org. If you are unable to provide a copy of the immunization record, please contact Jesse Westman at 973-3516 or jwestman@penquis.org and we will work with you to get a copy of that immunization record. Additional information is required to complete the application process: • Copy of Child's Official Birth Certificate • Proof of Income: W-2 or 1040 Tax Form and/or TANF (last 12 months) and/or SSI and/or Social Security Benefits You can email those documents to jwestman@penquis.org or you can mail them to Penquis Child Development, PO Box 1162, Bangor, ME 04402-1162. *If neither of these options work, please contact Jesse Westman at 973-3516 and we will figure out another way. In accordance with Federal Regulations, Penquis does not discriminate in access to or the provision of its services. By submitting this application online, you are stating that you understand that this application serves as an application for both preschool, Head Start and Early Head Start services. If it is determined that your child is eligible, you agree that this online application will serve as the application for Head Start or Early Head Start. Thank you for your interest in Penquis Child Development. We will be in touch soon to let you know the status of your application.
Required information is missing, see above.