Welcome to Mountain States Early Head Start, a free child development and parenting support program for families with infants and toddlers and pregnant women. We provide services in Bonner, Kootenai, and Shoshone counties.
Parent/Guardian
Please complete the application with as much information as possible. If you are applying as a pregnant participant, complete the Child (Applicant) section with first name as "Baby" and Birthday as your due date. Any information you share with us will be protected and you and your family will be informed if and when information needs to be share with authorized professionals. Thank you for your time. We look forward to working with you and your family.
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Non-binary
Refused
Unspecified
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
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Please complete the address information below.
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
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Non-binary
Refused
Unspecified
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
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
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Family Information
Please complete the following family information, including emergency contacts.
Number in Family
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
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Child (Applicant)
Please complete information for each child under the age of 3 applying for services. **If this is a pregnancy, complete the Child (Applicant) section with first name as "Baby" and Birthday as your due date.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
Non-binary
Refused
Unspecified
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Other Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Doctor/Medical Home
Associated Dentists of Coeur d'A
Associates for Women's Health
Avondale Dental Center
Bear Creek Pediatrics
Benewah Medical Center
Blizzard, Sonya
Bonner General Health
Bonner Partners in Care
Bonners Ferry Family Medicine
Boward, Danielle
CHAS Valley Clinic
Childbirth Classes
Coeur d' Alene Pediatrics
Coeur OBGYN
Dance, Dentistry For Kids
Deaconess Hospital
Ellenbecker Eye Clinic
Eye Care for You
Family Health Associates
Gentle Care Dentistry-DDS
Hayden Lake Family Physicians
HazelTree Midwifery
Health Care for Women
Heritage Health - CDA
Heritage Health - Dental
Heritage Health - Kellogg
Heritage Health - Rathdrum
Holy Family Hospital
Ironwood Family Practice
Ironwood Vision Center
Journey Pediatric Therapy
Kaniksu Health Services - Dental
Kaniksu Health Services - Sdpt
KH Family Birth Center
Kidds Dental
KMC Outpatient Rehabilition
Kootenai Clinic Family Residency
Kootenai Clinic OBGYN - CDA
Kootenai Clinic OBGYN - PF
Kootenai ENT & Audiology
Kootenai Family & Internal Medic
Kootenai Family Care
Kootenai Health
Kootenai Vision Center
Lakeside Pediatrics & Adolescent
Lions Club (CDA)
McNamara Family Dental
Medicaid Transportation
Monroe, Mary RDN, LD, CLE
Mountain View Family Medicine
Mountain View Family Practice
Multicare Rockwood Pediatrics
Newport Hospital & Health
Norman, Natasha RDH, BS
North Idaho Direct Primary Care
North Idaho Eye Institute
Northwest Community Pediatrics
Northwest Pediatrics
Northwest Peds Ophthalmology
Oddy, Cassandra, RN
Osburn Family Medicine
Panhandle Health District Hayden
Pediatric Dental Center North Id
Pediatric Dental Center of N. Id
Pend Oreille Midwifery
Pend Orielle Health Care
Post Falls Family Medicine PA
Prairie Family Medicine
Providence Child Neurology
Providence Liberty Lake Peds
Providence Maternal Fetal Med
Providence Pediatrics-North
Richardson, Cindi
Sacred Heart Medical Center
Sandpoint Family Medicine
Sandpoint Health Care
Sandpoint Pediatrics (Kaniksu)
Sandpoint Women's Health
Sdpt Family Health Center
Shoshone Medical Center
Silver Lake Dental
Spokane Audiology Clinic, Inc.
Spokane ENT
Spokane Eye Clinic
Spokane OB & GYN, P.S.
Spokane Pediatric Dentistry
St. Joseph's Ear Nose and Throat
Strand, Sharon
Tessendorf Family Chiropractic
Valley OBGYN
Valley Young Peoples Clinic
Walk-In Clinic
WIC/Panhandle Health-Sandpoint
Women Infant & Children
Women's Clinic Of North Idaho
Womens Health Center
Woodland Family Medicine
Young, Kimberly
Dentist/Dental Home
7 Day Dental Smiles
Associated Dentists of Coeur d'A
Avondale Dental Center
CHAS Valley Clinic
Coeur d’Alene Kids Dental
Dance, Dentistry For Kids
EWU Dental
Gentle Care Dentistry-DDS
Heritage Health - Dental
Ironwood Family Practice
John Doe
Kaniksu Health Services - Dental
Kaniksu Health Services - Sdpt
Kidds Dental
Kootenai Family & Internal Medic
Lakeside Pediatrics & Adolescent
Lifetime Dentistry
Little Smiles Pediatric Dentist
Loftus, George
McNamara Family Dental
Molly Gunsaulis, D.D.S.
Moss Family Dentistry
Mountain View Family Medicine
Mountain View Family Practice
Panhandle Health District Hayden
Pediatric Dental Center North Id
Pediatric Dental Center of N. Id
Post Falls Family Medicine PA
Prairie Family Medicine
River City Dentistry
Riverstone Dental Care
Sandpoint Family Medicine
Sandpoint Kid's Dentistry
Sandpoint Pediatrics (Kaniksu)
Scholes Family Dental
Sdpt Family Health Center
Silver Lake Dental
Spokane Pediatric Dentistry
Woodland Family Dental
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)
MSEHS 2023-2024 Program Year
Free, Home-Based Child Development Resources & Guidance for Anyone Expecting a Child or With a Child Birth to 36 Months
1st Location Preference
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2nd Location Preference
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- 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
Thank you for taking the time to complete the application. We look forward to providing helpful support and education for you and your family.
Required information is missing, see above.