This is the Douglass Community Services Head Start/EHS/CCP interest information worksheet. Here you can begin the process if you are interested in services for your 0-5 year old child or for yourself if you are a pregnant woman. We are a family oriented program that focuses on comprehensive services for school readiness. We have both home and center based services, and parents are an important part of everything we do! Please complete the information below. Once we receive the interest worksheet, we will contact you. We will need to get copies of your income information and your child's immunizations. We will want to see your child's birth certificate (or other documentation) and health insurance information. Don't worry if you don't have these documents. We will help you get them! If your child has special needs, be sure to let us know! We will review your child's IFSP or IEP and work with you on those goals! Thank you for your interest in our program!
This section is information on the primary adult in the family. This must be the child's legal parent, guardian or foster parent. If you do not have an email address please list as a default. If you are unsure of a question, please leave it blank.
Please list your mailing address and physical address below.
Click here to find a provider in your area.
This section is for the secondary adult in the family (if applicable) The secondary adult must be living with the child and related by marriage, blood or guardianship. If you are unsure of a question, please leave it blank.

Are there other adults in the household?

Add Another Adult
This section refers to your family as a unit. If you are unsure of a question, please leave it blank.
This section is information on the applying child. If you are unsure of a question, please leave it blank.

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 this interest survey. Someone will contact you within one week to do your application. They will verify the information and get copies of your income and your child's immunizations. Please call 573-221-3890 ext. 285 or 1-800-530-5016 ext 285 if you do not hear from a staff person within one week.
Required information is missing, see above.