The following is an Interest form for Next Door.
Parent/Guardian
Please answer questions based on the date of the application. For teen parents, only enter 'Yes' if 19 years or younger on the date of application.
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 Languages
American Sign Language
Burmese
Chin
Chinese
English
French
Hmong
Karen
Korean
Laotian (Laos)
Nepali
Other
Rohingya
Spanish
Thai
Other Language Proficiency
Little
Moderate
None
Proficient
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
Only complete this section if the Secondary Adult is currently living in the home, being supported by the same income and related by blood, marriage or adoption.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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.
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
African Languages
American Sign Language
Burmese
Chin
Chinese
English
French
Hmong
Karen
Korean
Laotian (Laos)
Nepali
Other
Rohingya
Spanish
Thai
Number in Family
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)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
EHS (HS) 2023-24
EHS CCP 2023-24
Head Start 2023-24
EHS 2023-24
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
You will receive an email confirmation once the application is submitted. We will contact you within 7 days to schedule an appointment to complete the registration process. You are responsible for updating contact information if it changes. We will only use the numbers and addresses submitted to notify you of your child status.
Required information is missing, see above.