Apply Online

Texas Tech University Center for Early Head Start is a program for children under age three, and pregnant mothers living in the city of Lubbock. Please complete the application below. Once your application is completed you will be prompted to upload your documents via a secure link. (IF YOU NEED TO APPLY FOR MORE THAN ONE CHILD, OR YOU ARE PREGNANT AND APPLYING FOR A CHILD, YOU WILL CLICK "ADD ANOTHER APPLICANT" AND SUBMIT IT AS ONE APPLICATION.) This program is an equal opportunity provider.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

HOMELESS STATUS- The McKinney-Vento Act of the United States government may allow you to declare your family as homeless, even temporarily. If you are experiencing any of the following, please check "YES" under "Is your family experiencing homelessness?" *In a shelter (family shelter, domestic violence, youth or temporary housing) *In a motel, hotel or weekly rate housing *More than one family member living together (doubled up with friends or relatives) due to loss of housing, economic hardship, or a similar situation *In an abandoned building, car or other inadequate accommodations *In a public place such as a park, bus station, RV park or camping ground

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.

Please include second parent or guardian information.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address

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

Hispanic

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

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

If you are applying as a pregnant mother, use "Pregnant Mother" as the name and fill in your due date in place of the child's birthday.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Race

Hispanic

Other Language

Primary Health Coverage

Medicaid Eligibility

Doctor/Medical Home

Dental Coverage

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

How did you hear about us (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

I certify that this information is true to the best of my knowledge. I understand that if any part of this information is willfully misrepresented, my participation in this program may be terminated and I may be subject to legal action. I also understand that this information will be held in strict confidence and is accessible to me during normal business hours. I understand that once my child is selected to receive Early Head Start services, they will remain eligible until their third birthday.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings