Apply Online

Welcome to Moore Community House's Early Head Start online application portal! This is the first step in the process to qualify your child for Early Head Start!! ~WE SERVICE~ Harrison County (Only) Pregnant Women to 36 Months New Applicants Only! If you have an existing application, please do not go any further. Call one of the following numbers to update your application and further instructions: 228-436-0881 (Biloxi), 228-436-0633 (Biloxi), 228-277-1010 (Gulfport). Income and age verification is required to determine your child's eligibility for acceptance and enrollment. Please complete all fields of this form and our staff will get back to you shortly with more information. Once the application has been initiated it must be completed and submitted! The application will not save!

Primary Adult is defined as the individual related to the child applicant by blood or marriage: it may also be the legal guardian or social worker who presents legal documents verifying their status.

First Name (Required)

Middle Name

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.

SSN

Race

Hispanic

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

All applicants must reside in Harrison County. Living address is define as where the family resides. Mailing address is define as where the family wants their mail to be sent.

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

Secondary Adult is define as the other adult family member related to the child applicant by blood or marriage and provides support to the family.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

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.

SSN

Race

Hispanic

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

Family is define as all persons living in the same household who are supported by the child's parent(s) or guardian(s) by blood, marriage, or adoption: or the child's authorized care giver or legal responsible individual.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language 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?

WIC ID (if applicable)

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

Applicant is the infant, toddler, or pregnant mother for whom this application is being processed.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

SSN

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

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?

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 your interest in the Early Head Start Program. Once your application has been submitted, you will receive a phone call from a Family Service staff with instructions on what to expect next. In the mean time, start gathering the following document to determine eligibility. * Proof of birth for all children applying * Proof of residency (Harrison County Only) * Proof of income for all working adults in the household (wages, W2s, letter from employer, any assistance, SSI-SSA benefits, child support, Pell grant, etc..) * Proof of insurance * SNAP and WIC

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