****IF YOUR FAMILY IS ALREADY ASSOCIATED WITH, OR HAS PREVIOUSLY SUBMITTED AN APPLICATION WITH HEAD START/EHS/ECEAP PLEASE STOP HERE AND CALL 360 442 2800 OR EMAIL US AT headstart.info@lowercolumbia.edu**** Please fill in the form completely and accurately. All information will be kept confidential. It will be used to help us determine if your family is eligible for services and to prioritize your placement on the waiting list. If you have any questions about this application, or need any help in completing it, please call us at 360-442-2800 or email headstart.info@lowercolumbia.edu. We will be glad to help!
******Homeless is defined as children who are sharing homes with others due to economic reasons; living in motel/hotels or campgrounds, living in shelters; awaiting foster placement; does not have a nighttime residence; living in public spaces; or are living without water/electricity/heat/functional kitchen or toilet.******
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If you have any concerns for your child regarding vision, hearing, speech, learning difficulties, behavior, abuse/neglect or is on an IEP/IFSP, please list those concerns in the note section below. This section asks, "Is there anything else you want to tell us about your child".
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Lower Columbia College Head Start/ECEAP does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment. I certify that this eligibility information is true. I understand that the information in this application will be held in confidence within the agency and is accessible to me during normal business hours.
Required information is missing, see above.