Thank you for showing interest in our Early Head Start Program. We're glad you're here! Please complete and submit the information on this page. If you've previously submitted an application with us, please call (531)-999-3900 and ask for a member of our Intake team. This program is for age-eligible children; therefore, we can only accept applications for children that will be 3 years old or younger on or after August 1, 2024. Thank you!
Parent/Guardian
Please only apply for this program if your child will be 3 years old or younger on or after August 1, 2024.
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
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
White
Hispanic
Yes
No
How did you hear about us (Required)
Another Agency
Brochure
Family
Flyer
Friend
Local Business/Organization
Newspaper
Postcard
Radio
Social Media
TYPP
Walk In
Website
Address
Please enter your address below. You must live in Douglas County to qualify for this program.
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
Primary Language at Home
African Language
American Sign Language
Arabic
Asian
Burmese
Central American
Chinese
English
Farsi
French
Kashmari
Kurdish
Middle Eastern
Other Pacific Island
Porteguese
Russian
Spanish
Ukrainian
Vietnamese
Western European
Is another language being acquired or learned at home?
Yes
No
Child (Applicant)
Please enter your child's name as it appears on his/her birth certificate. Please remember to only submit this application if your child will be 3 years old or younger on or after August 1, 2024.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
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 Learning Center Partnerships 24-25
Location Preference
<p></p>
1st Location Preference
<p></p>
2nd Location Preference
<p></p>
3rd Location Preference
<p></p>
- 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 the Early Learning Centers. We will contact you to set up an intake appointment.
Required information is missing, see above.