Thank you for your interest in the Early Head Start and/or Head Start program. Please complete all the "required" boxes and provide a phone number and email where we can reach you at. This will ensure your child's application is processed.
Parent/Guardian
First Name (Required)
Last Name (Required)
Suffix
Nickname
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
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Chinese
English
French
Hawaiian
Ilocano
Japanese
Marshellese
Other
Portuguese
Samoan
Spanish
Tagalog
Thai
Tongan
Vietnamese
Visayan
Yapese
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
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
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
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.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Suffix
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
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Chinese
English
French
Hawaiian
Ilocano
Japanese
Marshellese
Other
Portuguese
Samoan
Spanish
Tagalog
Thai
Tongan
Vietnamese
Visayan
Yapese
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
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
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
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
American Sign Language
Arabic
Chinese
English
French
Hawaiian
Ilocano
Japanese
Marshellese
Other
Portuguese
Samoan
Spanish
Tagalog
Thai
Tongan
Vietnamese
Visayan
Yapese
Number in Household
Number in Family
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)
First Name (Required)
Last Name (Required)
Nickname
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Chinese
English
French
Hawaiian
Ilocano
Japanese
Marshellese
Other
Portuguese
Samoan
Spanish
Tagalog
Thai
Tongan
Vietnamese
Visayan
Yapese
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Medicaid
No Insurance
Private Health Insurance
Doctor/Medical Home
Aiea Medical
Allan, Tracy MD
Aloha Pediatrics
Anderson, Benjamin MD
Ayabe, Sharon S. MD
Bartholomew, Brandi MSN, APRN
Bautista, Rainer MD
Bhattacharya, Roxanne
Bryant-Greenwood, Bianca MD
Burris, J. Wayne, MD
Buxbaum, Evan MD
Cameron, Mary CFNP
Carolan, Terry MD, FAAP
Carreau, Brigitte MD
Carrington, Erin
Chatkupt Surachat MD
Chen, Richard W. MD
Chong-Hanssen, Damien MD
Clinical Manager
Coleman, Malia MD
Collo, Cindy M.D.
DelaPena, Sharon
Dembeck, Katrina, FNP
Dempsey, Anne MD
Department of Health
Diep, Vinson
Dr. Aries Kuo
Dr.Aries Kuo
Dr.Maya Green
Dupree, Ralph MD
Edinger, Chloe
Emilia Suarez
Erica Tabalba
Esaki, Paul MD
Evslin, Lee MD
Fujiyoshi, Carol M.D.
Galiza, Grace MD
Gooddale Richard MD, CTH
Graham Chelius
Guillermo, Sorbella M.D.
Guyton, Amy
Haack, Dennis, MD
Hatch-Pigott, Virgina, MD
Ho'ola Lahui Hawaii
Hong, Trudy
Horton, Cynthia
Hunter, Charlotte MD
Jasmine Maes/ Nightbloom Biirth
Kalihi Palama Health Center
Kapa'a Pediatrics LLC
Kapaa Dental Center
Kapiolani Medical Center
Kato, George FNP
Kauai Community Health Center
Kauai Coomunity Health Alliance
Kauai Medical Clinic
Knox, Jami MD
Kokua Kalihi Valley
Krebs, Clara MD
Kristen L-B Darrell, MHS, PA-C
Laird, Jack
Lam, Jesse MD
Lam, Sarah MD
Lin, James MD
Martinez, Raymond MD
Medeiros, Kapua
Menezes, Melinda MD
Moore, Sally PA-C
Murata, Alyssa MD
Murphy, Jay MD
Murray, Michael MD
Nagamine, John
Naro Torres
Nelson, Carla MD
Nelson, Suzanne MD
Netzer, Roger MD
Newman, Erin
Noel, Erika M.D.
North Shore Medical Center
Nunez, Goel MD
Nutritionist
Ogai, Yuliya MD
Ono, Craig M. DDS
Pena, Sierra MD
Penner, Steven MD
Purcell, Heidi MD
Quensell, Josephine M.D.
Raelson, James MD
Rao, Spinadh MD
Reis Pediatrics
Relles, Natalie
Richardson, Tracey MD
Riola, Bernard MD
Robert Stebbins
Rogoff, Steve MD
Ross, Paul MD
Saito, Syuck Ki MD
Sang, New MD
Scheppers, Dennis MD
Schultz, Jill RN
Sciaroni, Daniel DO
Snow-Mills, Tracy
Snyder, Lena MD
South Shore Medical Clinic
Splittstoesser Lisa, MD
Tanabe, Brian M.D.
The Clinic at Port Allen
The Specialty Clinic In Kalaheo
Torrijos, Emma MD
Tracy Jo Snow mills
Tropic Care
Trpkovski, Tony N. MD
Tumbaga, Beverly, APRN
Turlington, Alicia
Uyehara-Isono, June Au D. FAAA
Waiane Coast Comp. Health Center
Weiner, Linda MD
West Kauai Clinic
WIC
Wichert, Jami MD
Williamson, Thomas MD
Winchell, Jilliene MD
Wotring, Robert MD
Yonohara, Maria MD
Young, Geri MD
Yu, Carl MD
Yu, Carol
YWCA
Dental Coverage
Medicaid
No Insurance
Private Health Insurance
Dentist/Dental Home
Adams, Caley DDS
Allen, Terry DDS
Apalla, Antolin DDS
Asato, Todd
Baird, Kanoe DDS
Baird, Mark, DDS
Black, John DDS
Brown, Ralph Anthony M.D.
Bundschuh, Lauren DDS
Carreno, Ileana DDS
Ching, Brent
Ching, David
Chuah, Ivan DDS
Chun, Jo Jan DDS
Chunia, DDS
Clay Hiramoto DDS
Community Case Management Corp.
Dr. Aries Kuo
Dr. Ricardo Fernandez
Dr.Aries Kuo
Eghbarieh, Ameer
Fasig, Kenneth DDS
Fisher, Samantha RDH
Fujimoto, Lloyd DDS
Furgeson, Michael D.D.S
Godla, Chris DMF
Gore, Richard DDS
Hamamoto, Paul DSS
Haruki, Craig R., DDS
Hawaii Family Dental
Hawaii Pacific Dental Group
Hawaiian Island Dental
Hirano & Hirano DDS
Hirose, Rhinelle DDS
Ho'ola Lahui Dental Office
Hoku Smiles Pediatric Dentistry
Hori, James M. DDS
Imai, Lauren DDS MS
Ing, Alan DDS
Jaurequi, Randall DDS
Kalaheo Dental Group
Kalihi Palama Health Center
Kapaa Dental Center
Kauai Dental Studio
Kauai Sparkless Dental
Kerns, Amanda DDS
Kim, Howard DDS
Kim, Spencer D.D.S.
Kobayashi, Michelle D.D.S, M.S.D
Kokua Kalihi Valley
Kuhio Pediatric Dental
Layman, Bobby DDS
Lee, Christopher DDS
Leeward Pediatric Dentistry
Leone, Erica
Leong Family Dental
Li, William DDS
Lihue Dental
Long, Robert DDS
Lutwin, Michael
Masenior, Jeremy DDS
Mashahiro Shane Satta D.D.S.
Murphy, Shawn DDS
Naganuma, Greg DDS
Premier Dental Group
Quade, Ronald DDS
Rebmann, Coy DSS
Rita, Kelliann DDS
Saker, Peter DMD
Sanchez, Patricia DDS
Satta, Masahiro Shane DDS
Schafermeyer, Josep DSS
Seager, William
Stebbins, Robers DDS
Sullivan, Coleen
Sumikawa, Bert D.D.S
Sumikawa, David DSS
Sumikawa, Mark DSS
Taudel, Mary DDS
Tom, Derek DDS
Toothbuds Kaua'i
Tsunehiro, Cathy N. DDS
Uyehara, Keith Y. DDS
Virtual Dentistry Home
Waiane Coast Comp. Health Center
Westphal, Joshua
Westside Christian Center Church
Xue S. Zhao
Yamada, Chris DDS, MS
Yamaguchi, Randy DDS
Yim, Paul Dr.
Yoo, Paul
Yu, Carol
Zhao, Shirley DMD
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
Head Start 2023-2024
1st Location Preference
<p></p>
2nd Location Preference
<p></p>
- 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 Early Head Start and/or Head Start program. Parent Certification: By click "submit" you are accept Early Head Start and/or Head Start services and certify that is information is true. If any part is false, my participation in this agency's program may be terminated. I also understand that the information on this application will be held in strict confidence within the agency and is accessible to me during normal business hours. Someone will contact you to schedule an application interview. If you do not hear from us within 5 days from the submission of your application, contact the main office at 808-245-5914.
Required information is missing, see above.