Apply Online

Thank you for your interest in the Santa Cruz County Head Start/Early Head Start Program. We serve children and families through high-quality early childhood centers and offer a wide range of services, including school readiness, health and nutrition, social-emotional development, disability and mental health supports, parent services, and more. Please be sure to complete all sections of the application. Missing required information may cause errors and delay the processing of your application.

First Name (Required)

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.

Race

Hispanic

Lives with Family

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

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.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

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 Household

Number in Family

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?

WIC ID (if applicable)

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

Add Emergency Contact

First Name (Required)

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Insurance Number

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

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 submitting your online application. A Family Service Advocate will reach out to you soon to schedule a follow-up appointment. To ensure a smooth process, please have the following documents ready for your appointment: - Proof of income, such as Cash Aid, SSI, Unemployment Benefits, a Foster Placement Letter, or one month’s worth of pay stubs for each parent/guardian in the household. - Birth certificate for the applying child. - Immunization records for the applying child. - Medicaid or insurance card for the applying child. - Court-ordered documents, if applicable, such as custody papers or restraining orders. - IEP or IFSP for the applying child, if applicable.

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