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Thank you for your interest in enrolling in our Healthy Parents & Babies program, in Illinois.

We serve families prenatally through birth, and up to age 3 for their children. Persons must be pregnant to qualify for doula services, but can be of any age and at any stage of their pregnancy. Parents can qualify for our home visiting services at any point post-birth through the age of 3 for their children.

To start the enrollment process, please complete this initial contact form and someone will contact you within 48 business hours. If you have immediate questions regarding the status of your application, please call (312) 975-1273 or email cmarquez@startearly.org.

Note: Participation is not limited to first-time parents or new participants and eigibility for Early/Head Start programs is determined based on a range of factors, including the federal poverty guidelines. See Eligibility Guidelines Here.

We encourage you also to collect the following pieces of information to help speed up the next phase of the application process:

Original birth certificate for child(ren)
Employment Documentation (W2s, income taxes, unemployment benefits, public assistance statement of benefits)

Additional documents may be uploaded once the application is completed or brought to the enrollment interview once contacted by someone from the program.

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 (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent (Required)

If Teen Parent, Subsidized?

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.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

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 (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent (Required)

If Teen Parent, Subsidized?

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home?

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)

WIC ID (if applicable)

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)

If applying for multiple children in one family, complete the Additional Applicant section for each applying child (see below).

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Medicaid Eligibility (Required)

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

Referral Source (Required)

Specify Referral Source (Required)

Migrant/New Arrival? (Required)

Concerns about child? (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

Thank you for completing the application. Once you submit your application, you will be redirected to a confirmation page with an “OK” button. Please click the “OK” buttonto continue to onto critical information about the enrollment process, contact details and documents you will need to collect to complete your enrollment process.

Someone will contact you within 48 hours about your application.

If you have immediate questions regarding the status of your application, please call (312) 326-2754 or email cmarquez@startearly.org.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings