Thank you for your interest in Adams-Brown Head Start/Early Head Start. We provide services to prenatal women through children age 5! This online pre-application is the first step in the enrollment process and may be completed by the parent or legal guardian. Please note: Do not complete the online pre-application if your child is eligible for re-enrollment in the program. Contact our Main Office at 937-378-6041 Ext. 244 for further assistance.
Parent/Guardian
Please complete all sections below.
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.
SSN
Lives with Family
Yes
No
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Provides Financial Support
Yes
No
Address
If a person does not have permanent housing (who may be living in the streets, staying in a shelter, a mission, individual room facilities, an abandoned building or vehicle, or is in any other non-permanent situation) then he or she can qualify as homeless. It can also be considered that a person has no home if that person is "doubled", a term that refers to a situation in which people can not maintain their housing situation and are forced to stay with a number of friends and/or members of the extended family.
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
Family Information
For TANF, SSI, WIC or SNAP only answer 'Yes' if currently receiving these benefits.
Number of Parents/Guardians
One Parent Family
Two Parent 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
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Child (Applicant)
Make sure that the child's name on the application matches the child's name on their birth certificate.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
SSN
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
HS 2025-2026
EHS 2025-2026
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
Thank you for your interest in Adams-Brown Head Start/Early Head Start Program. By clicking the button below you certify that the information you have provided is complete and accurate. Our Recruitment Specialist will contact you to set up an intake appointment. If you have not heard back within 5-7 business days, please contact Adams-Brown Head Start/Early Head Start at 937-378-6041 Ext. 244 or 237. **Completing this form does not mean your child is enrolled**
Required information is missing, see above.