Apply Online

Please fill out the application with as much information as you can. The application process consists of enrollment information as well as a screener for the child you are applying for. Filling out the application does not guarantee enrollment into the Eastern Oregon University Head Start Program. Enrollment is based on age, income eligibility, and family need. Enrollment for the preschool program takes place in summer for the next school year and year round for openings that come available. Enrollment for our Early Head Start Home Visiting Option takes place year Round! Thank you for applying to our program.

First Name (Required)

Middle Name

Last Name (Required)

Nickname

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.

Race

Hispanic

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

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)

Nickname

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.

Race

Hispanic

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

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?

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

1. Please tell us the date of your child's last well-child check and any upcoming appointments in the Notes Section Below. 2. Please also tell us about any medication or food allergies or any special health needs or conditions in the Notes Section Below. 3. Please share with us if you are working with other agencies such as Babies First or Early Head Start in the Note Section Below.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

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)

1st Location Preference

2nd 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

Remember filling out the application does not guarantee enrollment into the Eastern Oregon University Head Start Program. Enrollment is based on age, income eligibility, and family need. Enrollment for the preschool program takes place in summer for the next school year and year round for openings that come available. Enrollment for our Early Head Start Home Visiting Option takes place year Round! Once you click the submit application button below, you will be directed to a site to complete a screener regarding your child's development. If you have any questions or need support with the forms please call 541-786-5535. Thank you for applying to our program.

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