Welcome to the San Luis Valley Early Head Start online pre- application. Thank you for your interest in our program. As you begin the application, please be sure to enter into all fields, to ensure your application is complete. Our office phone number is 719-937-4010
Parent/Guardian
First Name (Required)
Last Name (Required)
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.
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Family Information
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
Chinese
English
French
German
Kanjobal
navajo
Russian
Spanish
Spanish
Is another language being acquired or learned at home?
Yes
No
Number in Family
Gross Annual Income
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Location Preferences
Which program are you applying for? (Required)
EHS 2024-2025
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
Thank you for your interest in the San Luis Valley Early Head Start Program, by clicking the button below you certify that the information you have provided is complete and accurate. We will contact you to set up an appointment to finish the application process.
Required information is missing, see above.