Applications are accepted year round

All families are encouraged to apply!

Welcome to Child Start! Please complete all fields of the application in order to establish eligibility.

You will need an email address to complete this online application. Submitting Applications with multiple email addresses will slow down your application process. Families experiencing homelessness; foster children and parents that receive CalFresh (SNAP),Temporary Assistance for Needy Families (TANF) or Supplemental Security Insurance (SSI) are given the highest priority for enrollment.

If you already applied or have previously had a child participate in a Child Start program, DO NOT fill out this online application form. Please contact us at 1-866-573-4274 for further assistance. Thank you.

Other considerations are given to over-income families depending on their individual circumstances, including children with disabilities that have a current Individualized Family Services Plan (IFSP) or Individualized Education Plan (IEP).

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.

Race

Hispanic

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

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)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

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.

Race

Hispanic

Highest Grade Completed

Employment Status (Required)

Child's Relationship (Required)

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home?

Number in Family (Required)

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 from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Race

Hispanic

Other Language

Medicaid Eligibility

Medicaid Number

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

After your application is submitted, a staff person will contact you to schedule an “Intake Appointment” to determine if you are eligible for the program.

These documents will be required to determine if your child is eligible for the program:

Proof of income (copy of 1040 tax return within 1 year and 1 full month’s worth of pay stubs) NOTE: If it is a 2 parent/guardian household, we will need income from both parents/guardians
Up to date Immunization Record
Proof of age (ex. Birth Certificate, Medi-cal card)
Medi-Cal card or Insurance #

Bring these documents to your appointment. If you are having trouble obtaining a copy of your income or if you have any questions, please contact us for assistance.

If applicable, please also bring a copy of the following:

Current copy of child’s IEP/IFSP
Supplemental Security Income Statement
Foster Care Statement
TANF/ CalWorks/ CalFresh (SNAP) Notice

This is the first step in the application process and does not guarantee acceptance. Please note, the enrollment process can take longer to complete if your family income exceeds the poverty guidelines or if we are fully enrolled.

Required information is missing, see above.

Applications are accepted year round

All families are encouraged to apply!

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings