Thank you for your interest in our Early Head Start Program. The information you will be providing is to refer yourself of families you know to initiate the application process, for prenatal mothers and children birth to 2.5 years of age. * Note: If you are a prenatal applicant please complete information in the Parent/Guardian section and Child Applicant section. If you have previously submitted an Early Head Start Program application or referral, please DO NOT re-submit an online referral. Instead please call (559) 263-1550, as we may already have your information in our system.
Parent/Guardian
First Name (Required)
Last Name (Required)
Suffix
Birthday (Required)
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
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.
Other Language
American Sign Language
Amhric (African)
Arabic
Armenian
Bengali (Bangladesh)
Cambodian
Cantonese Chinese
Chinese
English
Farsi
French
German
Hmong
Italian
Japanese
Khmer
Laotian
Mandarin Chinese
Mein
Mixteca
Panjit
Phillipino
Portuguese
Punjabi
Russian
Somalian
Spanish
Tagalog
Telugu (East Indian/Asian)
Thai
Tigran (Eithiopian)
Ukraine
Urdu
Vietnamese
Yemen
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
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
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Location Preferences
Which program are you applying for? (Required)
2023-2024 Early Head Start
1st Location Preference
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2nd 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
You have successfully submitted your Head Start 0-5, Early Care & Education Online Referral, you will be contacted by our staff within 1-2 business days.
Required information is missing, see above.