(Para la Aplicación en Español Presione Aquí)
Please fill out the form below using the legal name for parent(s) and child(ren). Please note that all information will be verified through a phone interview, if applying for a child, we will request proof of age documentation. Pregnant women interested in the program are only eligible for Early Head Start Home Base; the online application cannot be used to apply in advance for the Early Head Start Center Base option before the child is born. After completing the application, please review our homepage to access the Application Documentation Checklist to find out which documents are needed to finish determining eligibility. The documents can be submitted by email at enrollment@ochsinc.org, faxed to 714-640-2332 or in person at the Administrative Office or at any center.
Parent/Guardian
First Name (Required)
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
Home Phone
Work Phone
Ext.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African (Swahili, Wolof)
Carabian Languages (Haitian-Creole)
East Asian Languages
English
European & Slavic (German, Italian)
Middle Eastern & South Asian
Native Central/S.American & Mexican
Native N.American/Alaskan Native
Other
Pacific Island (Palauan, Fijian...)
Spanish
Unspecified
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Secondary adult must be supported and living in this household.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Mobile Phone
Home Phone
Work Phone
Ext.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African (Swahili, Wolof)
Carabian Languages (Haitian-Creole)
East Asian Languages
English
European & Slavic (German, Italian)
Middle Eastern & South Asian
Native Central/S.American & Mexican
Native N.American/Alaskan Native
Other
Pacific Island (Palauan, Fijian...)
Spanish
Unspecified
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Lives with Family
Yes
No
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Primary Language at Home
African (Swahili, Wolof)
Carabian Languages (Haitian-Creole)
East Asian Languages
English
European & Slavic (German, Italian)
Middle Eastern & South Asian
Native Central/S.American & Mexican
Native N.American/Alaskan Native
Other
Pacific Island (Palauan, Fijian...)
Spanish
Unspecified
Number in Family
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African (Swahili, Wolof)
Carabian Languages (Haitian-Creole)
East Asian Languages
English
European & Slavic (German, Italian)
Middle Eastern & South Asian
Native Central/S.American & Mexican
Native N.American/Alaskan Native
Other
Pacific Island (Palauan, Fijian...)
Spanish
Unspecified
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Early Head Start 2019-2020
Free Preschool for Children Ages 0 - 2 years 9 months
Head Start 2019-2020
Free Preschool for Children Ages 2 years 10 months - 5 years old
1st Location Preference
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2nd 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
Required information is missing, see above.