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Thank you for your interest in HCESC Head Start/Early Head Start. HCESC Head Start serves income eligible children living in suburban school districts in Hamilton County Ohio.

Estimated time to complete this form is 10 minutes

If you need assistance completing this application or have had a child previously enrolled in our Head Start or Early Head Start please call 513-674-4329. (Translation services available upon request)

Complete this section to tell us about you.

First 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

Opt In for Text Messages

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.

Race (Required)

Hispanic (Required)

Lives with Family (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Food Insecurity 6 month (Required)

Employment Insecurity 6 M (Required)

Housing Insecurity 6 Mo (Required)

New Health Concerns (Required)

New Mental Health Concern (Required)

Use Address Line 2 for apartment number

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 complete this information regarding your child's other parent.

Is there another parent/guardian in the family?

First 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.

Race (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent

Please answer these questions about your family.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home?

Number in Household (Required)

Number in Family (Required)

Gross Annual Income

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)

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?

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

Add Emergency Contact

Complete this section to tell us about the child(ren) you would like to enroll in Head Start or Early Head Start

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

Lives with Family (Required)

Other Language

Primary Health Coverage (Required)

Other Coverage

Insurance Number

Medicaid Eligibility (Required)

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

Dentist/Dental Home

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?

Medicaid HMO (Required)

Behavior Concerns? (Required)

Eating Concern? (Required)

History of Trauma? (Required)

Learning Concerns? (Required)

Motor Skill Concerns? (Required)

Speech Concerns? (Required)

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

Thank you for your interest in HCESC Head Start/Early Head Start. We accept pre-applications throughout the school year. Please look for an email from our data partner ChildPlus confirming that we received your application and giving you further information.

Congratulations on completing Step 1 in your child's journey to Kindergarten Readiness!

If you do not receive an email, please check your junk or spam files.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings