Please complete this form to begin the UTRGV-EHS-CCP Program application process. Please fill out as much information as possible.
Parent/Guardian
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender (Required)
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 (Required)
Opt In for Text Messages
Yes
No
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.
SSN
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
English
European/Slavic Languages
Spanish
Spanish
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
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
Family Information
For TANF, SSI OR SNAP only answer "Yes". Please include letters in the attachments.
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
English
European/Slavic Languages
Spanish
Spanish
Is another language being acquired or learned at home?
Yes
No
Number in Family
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program? (Required)
Yes
No
Is your family receiving Supplemental Security Income (SSI)? (Required)
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? (Required)
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)
If your child has an IFSP in place, please give a brief description in the notes section below.
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender (Required)
Female
Male
SSN
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
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
English
European/Slavic Languages
Spanish
Spanish
Does your child have a disability or do you have any concerns about your child's development? (Required)
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Pregnant Mothers, Infant, Toddlers
Pregnant Mothers and Children 6weeks to 3 years of age.
2025-2026 School Year
Pregnant Mothers and Children 6weeks to 3 years of age.
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 our Early Head Start Program.
Required information is missing, see above.