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Thank you for your interest in Lewis County Head Start. We are a federally funded program and offer quality services for families and school readiness opportunities for children. To be age eligible for our program a child must be 3 or 4 by August 31st of the year for which you are applying. If your family has attended our program in the past, please call 360-736-1696 Ex 123 to complete your child’s application.

First Name (Required)

Middle Name

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 (Required)

Opt In for Text Messages

Home Phone (Required)

Work Phone (Required)

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

Other Language

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

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.

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)

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

Other Language

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support

Are there other adults in the household?

Add Another Adult

We will need proof of income for the last 12 months. This can be your income tax information (if the income is still the same), or, year to date check stubs. If you receive TANF, SSI. or SNAP we will need a copy of your award letter.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home

Number in Household (Required)

Number in Family (Required)

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program? (Required)

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? (Required)

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

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

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race (Required)

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?

How did you hear about us (Required)

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 interest in Lewis County Head Start. Please submit proof of income for the past 12 months (tax form 1040 or W-2 or year to date check stubs, or proof of TANF, SSI, SNAP Benefits) AND copy of birth certificate/immunization record so that we can process your application. Documents can be faxed to 360-736-0090, emailed to kronnell@lewiscountyheadstart.org or drop off at 203 West Reynolds Avenue in Centralia. Please click 'submit' and we will contact you in the near future to discuss the next steps in the process.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings