Thank you for your interest in the Lower Elwha Children's House of Learning Head Start Programs. This application will allow you to apply for Head Start or Early Head Start.
Parent/Guardian
Please enter the following information about the primary adult in the household
First Name (Required)
Last Name (Required)
Nickname
Birthday (Required)
Gender (Required)
Female
Male
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 (Required)
Opt In for Text Messages
Yes
No
Home Phone (Required)
Work Phone (Required)
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
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic (Required)
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
English
Japanese
Klallam
Mandarin
Russian
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
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
Custody
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
If Teen Parent, Subsidized?
Yes
No
Address
Please list your physical address, as well as your mailing address.
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 (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
Additional Parent/Guardian
Please fill in the following information about the secondary adult responsible for the applicant.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
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.
SSN
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
English
Japanese
Klallam
Mandarin
Russian
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
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
Custody
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
If Teen Parent, Subsidized?
Yes
No
Family Information
Please fill in the following information about your family.
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
American Sign Language
Arabic
English
Japanese
Klallam
Mandarin
Russian
Spanish
Is another language being acquired or learned at home?
Yes
No
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?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
WIC ID (if applicable)
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
Please fill in the following information about the child you are applying for.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
SSN
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
English
Japanese
Klallam
Mandarin
Russian
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Other Coverage
Children's Health Insurance Program (CHIP)
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Insurance Number
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Medicaid Number
Doctor/Medical Home
Bogachiel Clinic
Cottage Community Birth Center
Dr. Andrew Symonds
Dr. George Symonds, OD
Dr. Rob Epstein
Jamestown Clinic
Lower Elwha Health Clinic
Mary Bridge Children's Health C
Mauzzea Erin Phd
Neah Bay Clinic
North Olympic Healthcare Network
Olympic Medical Center
Olympic Medical Physicians
Pediatrics Northwest
Peninsula Children's Clinic
Peninsula Women's clinic
Quileute Health Clinic
Seattle Children's Hospital
Silverdale Eye Physicians
UW Medical Center MICC
Western Montana Pediatrics
Dental Coverage
Children's Health Insurance Program (CHIP)
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Dental Coverage Number
Dentist/Dental Home
ABC Dental Care
Bainbridge Kids Dentistry
Dentist for Children
Dr. Anguel Mantchev
Dr. Davies Dental
Dr. Selander
Dr. Shelly Self
Eleven Eleven Dental
Jamestown Dental Clinic
Kitsap Kids' Dentistry
LaPush Dental Clinic
Laurel Dental
Lower Elwha Dental Clinic
Neah Bay Clinic
NOHN Dental
North Olympic Healthcare Network
OlyCAP Oral Health Care
Olympic Kids Dental
Quileute Dental
Quileute Health Clinic
Sea Mar Dental
Siemens. James V.
Skerbeck, K Ben, DDS PS
Steim Family Dentistry
Swenson 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)
2025-26 EHS
2024-2025 School Year
Head Start - ages 3-5 years
2024-2025 School Year
Early Head Start - ages 0-3 years
2025-26 Head Start
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd 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
Once you have completed the pre-application, our Family Community Partnership Manager will contact you to complete the application process and get you on our waitlist of enrollment.
Required information is missing, see above.