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Thank you for applying for Early Childhood Education Services with People Incorporated. We offer Head Start services for 3 and 4-year-olds in Bristol City, Clarke County, Frederick County, Russell County, Winchester City, and Washington County, VA. Head Start is available as a home based option in Russell County. We offer center based Early Head Start for Infants and Toddlers up to their third birthday in Dickenson County, Abingdon, and the city of Bristol, Virginia. Early Head Start is available in a home based option in Buchanan County, Dickenson County, Russell County, Washington County and the city of Bristol, Virginia. We can enroll prenatal moms in home based Early Head Start, if you are pregnant and wish to apply for Early Head Start prenatal services please call 276-619-2213. Our Dickenson County center also offers affordable childcare through full-day infant-toddler and preschool classrooms, before and after school childcare and full-day summer care for children 3 -12 years old. Please answer each question. If you experience difficulty in completing the application please call 276-619-2252 or 276-619-2213.

Please complete these questions for your family's head of household.

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

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Please enter your living address. If your mailing address is different than your living address, un-check the blue box below and also enter the address where you receive mail.

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

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Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Secondary adult should only be checked if related to the child by blood or marriage and living in the same home as the child, or shares equal physical custody of the child.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

English Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

The following questions help us determine eligibility and the types of documentation we will need to collect. Please answer all questions.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Household

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?

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

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

Add Emergency Contact

Please answer these questions for the child for whom you are applying.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

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

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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 completing an application. By clicking the button below, you are certifying that the information you've entered is complete and accurate. You will be contacted by program staff to schedule an intake interview.

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