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Welcome to Springfield Urban League and thank you for your interest in our Head Start and Early Head Start programs!

Our programs provide high-quality early childhood education, health and nutrition services, and family support for eligible children from birth to age five. Early Head Start serves children from birth to age 3 and pregnant women. Head Start serves children from ages 3 to 5 years old.

This pre-application is the first step in determining your family’s eligibility. Please take a few minutes to provide accurate and complete information. Once submitted, a member of our team will contact you to guide you through the next steps of the enrollment process. You should also receive an email confirmation.

Please Note: This is an interest form and does not guarantee placement in the program. It is the first step in the application process. All applications are subject to eligibility review and available space in our program.

Parent/Guardian

The Primary Adult must be the person enrolling the child. This should be a parent or legal guardian. -If you are a pregnant mother seeking services, please enter your own information. -If you are enrolling a child, you must be the child’s parent or provide legal guardianship documentation. -Relatives or caregivers without legal custody may not enroll a child. Please make sure this section is completed accurately, as it determines who is authorized for enrollment.

First Name (Required)

Middle Name

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)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent

If Teen Parent, Subsidized?

Address

Please enter the current physical address where your child and household members live. - Include street number, street name, apartment or unit number (if applicable), city, state, and zip code. -Make sure this is the address where your child actually resides most of the time. If your mailing address is different, list it separately in the designated mailing address field - Accurate addresses are important for eligibility and communication. Do not use temporary addresses unless this is where the child resides. If address changes after submitting application call our office to have it updated in our system.

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

Additional Parent/Guardian

Secondary adult refers to the second adult in the household who may play a role in the child's care and support. This adult should be related to the child by blood, marriage, or adoption. Two Parent Households should have both parents on the application.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

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 (Required)

Opt In for Text Messages

Home Phone (Required)

Work Phone (Required)

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)

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

If Teen Parent, Subsidized?

Other Adults

Are there other adults in the household?
Add Another Adult

Family Information

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)

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? (Required)

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

Emergency Contacts

Add Emergency Contact

Child (Applicant)

This is for the child that you are enrolling into the program.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Medicaid Eligibility

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?

Location Preferences

Which program are you applying for? (Required)

Head Start

Free Pre-K program for Children Ages 3 to 5

Early Head Start 2025-2026

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.

Additional Applicant

Do you want to apply now for another child in your family?
Add Another Applicant

Siblings

Are there other children in the family?
Add a Sibling

After submitting your pre-application, a member of our enrollment team will review your information and contact you to schedule an intake appointment or request additional documentation if needed. Please ensure your contact details are correct and check your phone and email regularly. If you have any questions, feel free to reach out to our office at 217-528-0895 Thank you for your interest—we look forward to supporting your child’s early learning and development. By clicking the button below you certify that the information you provided is complete and accurate.

Required information is missing, see above.