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Thank you for your interest in CAPE Head Start/Early Head Start. We serve the Indiana counties of Vanderburgh, Posey and Gibson.

NOTE: This application is for families applying for the FIRST TIME only. If any child in your family has ever applied for or attended our program, please do not use this application. Instead, please contact your Family Advocate or call: 812-425-4241 (for Vanderburgh County), 812-385-8305 (for Gibson County) or 812-838-4839 (for Posey County.) Returning children and their siblings may qualify for priority placement.

At the end of this application, you will be able to add additional applicants if desired. Please at least one location preference. Availability of specific classrooms may be discussed when we contact you.

In general, eligibility is based on family income at or below the poverty level. Families with other situations including homelessness, children in foster care, or receiving SNAP, SSI or TANF also are eligible.

Completing this form does not guarantee enrollment. Due to limited government funding, there may not be enough spaces for all eligible children. If there is not a space available at this time, your family will be placed on a waiting list to be contacted subject to availability and eligibility status of the applicant.

*Regarding "Employment Status": If this person is working AND going to school, select either "Full-time & Training" or "Part-time & Training."

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender (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

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent

If Teen Parent, Subsidized?

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

*Regarding "Employment Status": If this person is working AND going to school, select either "Full-time & Training" or "Part-time & Training."

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

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 (Required)

Hispanic (Required)

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent

If Teen Parent, Subsidized?

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned 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? (Required)

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

WIC ID (if applicable)

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps? (Required)

Is at least one parent/guardian an active duty member of the United States military? (Required)

Is at least one parent/guardian a veteran of the United States military? (Required)

Add Emergency Contact

If you are interested only in a Full-Day classroom (10.5 - 11 hours a day) please type the words "Full Day" in the last text box ("Is there anything else you want to tell us about your child?")

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Other Coverage

Medicaid Eligibility

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

After you have completed the above fields, please verify below and then click the "Save and Continue" button at the bottom of this page. You may then upload documentation or wait and provide it after we contact you. Click the "Submit Application" button. An acknowledgment of receipt will be sent to the email address you provided. Enrollment is not guaranteed. When space is available, a Family Advocate will contact you to discuss your child's eligibility and possible start date.

In the meantime, please feel free to call us for further information. Vanderburgh: 812-425-4241; Gibson: 812-385-8305; Posey: 812-838-4839.

Thank you for your interest in CAPE Head Start/Early Head Start.

All services are provided without regard to race, age, color, religion, sex, disability, national origin, ancestry, or status as a veteran.

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