Apply Online

Start the Application Process by completing this online form. Please indicate interest in Early Head Start (Pregnancy to Age 3) or Preschool (Age 3 or 4). Children must be age 3/4 on or before December 1 of the school year to be eligible for preschool. As part of the application process, you will need to provide: • Proof of birth • Annual income/eligibility documentation Completion of this interest form does not guarantee your child will be served by a publicly funded preschool program. IMPORTANT: If, after you enter your email address, you receive a message indicating that you have already applied you must contact Community Action Agency. Please contact Wendy Ketchens at 517-888-3768 or email wketchens@caajlh.org.

A note about Family Size - please enter all individuals, living in the same household that are related to the enrolling child by blood, marriage or adoption.

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.

Lives with Family

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

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)

Last Name (Required)

Birthday (Required)

Gender

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

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.

Lives with Family

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

If you have zero income, please enter as $1 dollar.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Family

Gross Annual Income

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 under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

If your child has an IEP (Individualized Education Plan) or IFSP (Individualized Family Service Plan) please select "yes" for the question "Does your child have a disability?" In the note area, please provide information about your child's specific needs. If you are a pregnant mother applying for Early Head Start, please enter parents information for First Name, Last Name, and Date of Birth.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Doctor/Medical Home

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?

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 starting your application. By completing and submitting this form you are giving permission for us to contact you regarding your child's potential eligibility. Community Action Agency and the Jackson County Intermediate School District will have access to the information you submit. You will receive a call from the Appointment Scheduler next. If you have any questions about this form or experience any problems while completing it, please contact Community Action Agency at 517-437-3346, press 3246 for assistance. You can also contact Wendy Ketchens at 517-888-3768 or email wketchens@caajlh.org. Parent Certification Statement: I certify that this information is true. If any part is false, my participation in this agency's programs may be terminated and I may be subject to legal action.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings