Apply Online

This pre-application is the first step in determining your family’s eligibility.

Please provide complete and accurate information. Once submitted, a member of our enrollment 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. All applications are subject to eligibility review and available space.

The Primary Adult must be the parent or legal guardian enrolling the child. If you are a pregnant mother applying for Early Head Start services, please enter your own information. Only a parent or individual with legal guardianship may complete this application. If you are unsure about guardianship requirements, please contact our office before submitting.

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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family (Required)

English Proficiency (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent

Please enter the physical address where your child currently resides. Include the street number, street name, apartment or unit number (if applicable), city, state, and zip code. This address must reflect where the child lives most of the time. If your mailing address is different, enter it separately in the designated field. Accurate address information is required to determine eligibility and transportation. If your address changes after submitting this application, please contact our office to update your information.

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.

A Secondary Adult is another parent or legal guardian who resides in the household and contributes to the child’s care and support. If applicable, please enter the information for the second parent or guardian. This adult must be related to the child by birth, marriage, or adoption. Accurate information is required to determine household size and eligibility. 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

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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family (Required)

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent

Are there other adults in the household?

Add Another Adult

Please provide complete and accurate information about your household. This information is used to determine eligibility, household size, and program priority categories. All household members and sources of assistance must be reported. Incomplete or inaccurate information may delay processing of your application

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)

Please enter complete and accurate information for the child you are applying to enroll. The child’s date of birth is used to determine age eligibility for the selected program. All required fields must be completed to process your application. You may add additional children in the next section.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family (Required)

English Proficiency (Required)

Other Language

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?

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

Please monitor your phone and email regularly.

If you have questions, please contact our office at 217-528-0895 ext. 1305 or ext. 1306, or email us at ersea@springfieldul.org.

By clicking the button below, you certify that the information provided is complete and accurate.

Thank you for your interest — we look forward to supporting your child’s early learning and development.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings