Please complete all fields. Missing information may result in delayed application process. If you have previously enrolled a child with our Head Start or Early Head Start programs, please contact: Baldwin Park ECE Center: (626) 856-4642 Tri Cities/Los Angeles Office: (323) 726-9092
Parent/Guardian
First Name (Required)
Middle Name
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.
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Sign Language
Cambodian
Caribbean
Chinese
East Asian
English
European / Slavic
Middle Eastern and South Asian
Native Central, South American, Mexican
Native North American/Alaskan
Other
Pacific Island
Spanish
Tagalog
Unspecified
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Employment Status
Employed
Employeed/Seeking Employment
Full-time & Training
Homemaker
Part-time & Training
Part-time (Under 35 hours/week)
Self-Employed
Student
Unemployed
Unemployed/Seeking Empolyment
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Family Information
Primary Language at Home
African
American Sign Language
Cambodian
Caribbean
Chinese
East Asian
English
European / Slavic
Middle Eastern and South Asian
Native Central, South American, Mexican
Native North American/Alaskan
Other
Pacific Island
Spanish
Tagalog
Unspecified
Vietnamese
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 include all children that you would like to enroll in the Head Start or Early Head Start Programs in this section.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Sign Language
Cambodian
Caribbean
Chinese
East Asian
English
European / Slavic
Middle Eastern and South Asian
Native Central, South American, Mexican
Native North American/Alaskan
Other
Pacific Island
Spanish
Tagalog
Unspecified
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
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)
Early Head Start 2023-2024
Pregnant women, infants and toddlers up to 35 months old
Head Start Program 2023-2024
Children ages 3 & 4
Early Head Start 2023-2024
Pregnant women, infants and toddlers up to 35 months old
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
Siblings
Are there other children in the family?
Add a Sibling
Thank you for your interest in the Head Start/Early Head Start program. We will contact you within a two week period, if you do not hear back from us within that time frame. Feel free to contact our offices. Baldwin Park ECE Center: (626) 856-4642 Tri Cities/Los Angeles Office: (323) 726-9092
Required information is missing, see above.