Apply Online

We serve 3 months - 36 months children and Pregnant Women.

2 locations:

PYG- Templo Poder y Gozo

4401 Theiss Road, Humble, TX 77338.

ECC- Ecclesia Lindale Campus

6615 Irvington Blvd, Houston, TX 77022.

For more information, please call (832) 413-1494

The following is a pre-application form for Urban Strategies Early Head Start for infants and toddlers.
If you are a Pregnant Woman and would like to complete an application, please call our office: (832) 413-1494.

First Name (Required)

Middle Name

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

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

Hispanic

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

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)

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

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

Hispanic

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned 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?

Add Emergency Contact

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

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

Thank you for your in interest our program. By clicking the button below you certify that the information you have provided is complete and accurate. We will contact you within 14 days to set up an intake appointment.

Required information is missing, see above.

PYG- Templo Poder y Gozo

ECC- Ecclesia Lindale Campus

The following is a pre-application form for Urban Strategies Early Head Start for infants and toddlers.
If you are a Pregnant Woman and would like to complete an application, please call our office: (832) 413-1494.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings

PYG- Templo Poder y Gozo

ECC- Ecclesia Lindale Campus

The following is a pre-application form for Urban Strategies Early Head Start for infants and toddlers. If you are a Pregnant Woman and would like to complete an application, please call our office: (832) 413-1494.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings

The following is a pre-application form for Urban Strategies Early Head Start for infants and toddlers.
If you are a Pregnant Woman and would like to complete an application, please call our office: (832) 413-1494.