Apply Online

Dear parents: Please complete the first step of the online Economic Improvement Council Early Head Start Program preschool application process for the 2023-2024 school year. A staff member will contact you to assist you in submitting any additional required documents to complete your child's application. • Documents that will need to be submitted are the following: Proof of income for the last 12 months or last calendar year for all members in the household: 2022 Income Taxes or W2 form, or last current pay stub(s)/LES for 2022, • WFFA/TANF letter. • 12 months of Child Support computerized printout for all children in the home. • SSI; SSDI, SSA, Retirement Benefits, Veteran's Benefits, Alimony, • Unemployment, Disability, etc. All income information must be for the last 12 months or last calendar year. Immunization information (must be completed when child begins school). Certified copy of child's birth certificate, or other proof of age if certified birth certificate is not available. If you have any questions about information that needs to be submitted, please contact Vanessa Jackson at Vanessa.Jackson@eicca.org or Dr. Landon Mason at Dr.Landon.Mason@eicca.org to speak with someone in our application office.

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.

Employment Status

Child's Relationship

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)

Birthday (Required)

Gender

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.

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

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?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

English Proficiency

Primary Health Coverage

Other Coverage

Medicaid Number

Doctor/Medical Home

Dental Coverage

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

I certify that the information given on this application is true and accurate and all income has been reported and is subject to verification by the program. I understand that this information is being given for services provided by federal and/or state funds and that deliberate misrepresentation of any information will disqualify me from services

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings