Thank you for your interest in the Early Head Start Program. Please complete the information below entirely to be considered for enrollment. Under the Location Preferences Section, you must select at least one Location Preference. The processing time of this application is depended on the number applications received. Once your application is reached, you will be contacted by a member of the enrollment team.
Parent/Guardian
Primary Parent/Guardian Information
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.
Employment Status
Employed
Homemaker
Self-Employed
Student
Unemployed
UNKNOWN
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Due to a loss of housing or economic hardship?
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.
Additional Parent/Guardian
Secondary Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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.
Employment Status
Employed
Homemaker
Self-Employed
Student
Unemployed
UNKNOWN
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
African Languages (e.g., Swahili, Wolof)
American Sign Language
Arabic
ARABIC
Armenian
Armenian
Assyrian
Burmese
Cantonese
Cantonese
Caribbean
Cebuano
Chaldean
Chamarro
Chaozhou
Chinese
Croatian
Dutch
English
European & Slavic Languages (e.g., German, French, Italian, Croatian, Yiddish, Portuguese,
Farsi
French
German
Greek
Gujarati
Hebrew
Hindi
Hmong
Hungarian
Indonesian
Italian
Japanese
Khmer
Khmu
Korean
Korean
Kurdish
Lahu
Lao
Llocano
Mandarin
Marshallese
Middle Eastern & South Asian Languages (e.g., Arabic, Hebrew, Hindi, Urdu, Bengali)
Mien
Mixteco
Native American Languages
Native Central American, South American, and Mexican Languages (e.g., Mixteco, Quichean.)
Native North American/Alaska Native Languages
Other Languages of China
Other Languages of the Philippines
Other non-English
Pacific Island Languages (e.g., Palauan, Fijian)
Pashto
Pilipino
Polish
Portuguese
Punjabi
Rumanian
Russian
Samoan
Serbian
Serbo-Croatian
Spanish
Spanish
Tagalog
Taiwanese
Thai
Toishanese
Turkish
Ukrainian
Unspecified
Urdu
Vietnamese
Vietnamese
Is another language being acquired or learned at home?
Yes
No
Number in Household
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Location Preferences
Which program are you applying for? (Required)
Early Head Start - School Year 24/25
Children Ages 0 to 3 years
Head Start - School Year 24/25
Children Ages 3 to 5
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
Siblings
Are there other children in the family?
Add a Sibling
Please ensure to select at least your 1st Location Preference
Required information is missing, see above.