Thank you for applying to Spokane Head Start/ECEAP/Early Head Start
Please complete all fields in the form below.
If you are a pregnant mother who would like to apply for our home visiting program, please call (509) 279-6901.
If you get a message saying that it
appears that you have previously submitted an application
, please call the location you want to apply to (list of locations and phone numbers here:
https://ccs.spokane.edu/Head-Start/Locations
) or call our main office at (509) 533-4800.
Parent/Guardian
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Sign Language
Amharic
Arabic
Bosnian
Burmese
Chin
Chinese
Chuukese
Croatian
Dari
English
Farsi
French
German
Hindi
Hmong
Italian
Japanese
Karen
Korean
Laotian
Marshalese
Moldavian
Nepali
Pashto
Polish
Romanian
Russian
Salish
Spanish
Spanish
Swahili
Tigrinya
Ukranian
Vietnamese
Zomi
Highest Grade Completed
Associate's Degree
Bachelor's Degree
Grade 10
Grade 11
Grade 9 or less
HS Grad/GED
Master's Degree
Some College
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Please make sure you enter the address where you receive your mail.
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
Click here
to find a provider in your area.
Additional Parent/Guardian
Select "Yes" and complete this section if a second parent or guardian is residing in the home.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Sign Language
Amharic
Arabic
Bosnian
Burmese
Chin
Chinese
Chuukese
Croatian
Dari
English
Farsi
French
German
Hindi
Hmong
Italian
Japanese
Karen
Korean
Laotian
Marshalese
Moldavian
Nepali
Pashto
Polish
Romanian
Russian
Salish
Spanish
Spanish
Swahili
Tigrinya
Ukranian
Vietnamese
Zomi
Highest Grade Completed
Associate's Degree
Bachelor's Degree
Grade 10
Grade 11
Grade 9 or less
HS Grad/GED
Master's Degree
Some College
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
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
African
American Sign Language
Amharic
Arabic
Bosnian
Burmese
Chin
Chinese
Chuukese
Croatian
Dari
English
Farsi
French
German
Hindi
Hmong
Italian
Japanese
Karen
Korean
Laotian
Marshalese
Moldavian
Nepali
Pashto
Polish
Romanian
Russian
Salish
Spanish
Spanish
Swahili
Tigrinya
Ukranian
Vietnamese
Zomi
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
Please complete this information for the child applying for enrollment in Head Start, ECEAP, or Early Head Start. Complete all fields relevant to your child.
*Note - If you are a pregnant mother who would like to apply for our home visiting program, please call (509) 279-6901.
NOTE
- Use the last box to tell us any other information you'd like us to know about your child, including:
Does your child have an IEP/IFSP?
Does your family have an open CPS case?
Is the child currently in foster or kinship care?
How did you learn about Head Start/ECEAP/Early Head Start?
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Sign Language
Amharic
Arabic
Bosnian
Burmese
Chin
Chinese
Chuukese
Croatian
Dari
English
Farsi
French
German
Hindi
Hmong
Italian
Japanese
Karen
Korean
Laotian
Marshalese
Moldavian
Nepali
Pashto
Polish
Romanian
Russian
Salish
Spanish
Spanish
Swahili
Tigrinya
Ukranian
Vietnamese
Zomi
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Infants and Toddlers
Early Head Start childcare and home visiting for children ages 0 to 3, and home visiting for pregnant women.
Preschool
Head Start and ECEAP preschool for children ages 3 to 5.
Home Visiting
Home visiting program for children ages 0 to 3, and pregnant women.
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
After submitting your application, you will be given the opportunity to upload documents (income documentations, immunizations record, legal documents, etc.) that will help expedite your enrollment. You will also receive an email detailing the next steps (please check your junk mail folder).
Required information is missing, see above.