Apply Online

Thank you for expressing interest in Kidco Head Start and Early Head Start. This is your first step to connecting your family with tuition free, high quality early childhood services. Upon submitting this form, you will receive an email verifying our receipt of your information. Due to a high number of requests, please allow 30 business days prior to calling our office to check the status of your interview. If you have already contacted our office to request an application interview, please do not submit this form.

Please complete and review all fields prior to submission. Incomplete or inaccurate fields may delay or prevent our ability to contact you to complete your application. If your information changes prior to our contacting you, please contact our main office at (541) 451-1581 to let us know.

First Name (Required)

Last Name (Required)

Suffix

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

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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Our program is only allowed to serve children/families whose home is located in Albany, Corvallis, Harrisburg, Lebanon, Philomath and Sweet Home school districts. If you do not reside in one of these districts, we are unable to provide services. If you do not live in our service area, we'd be happy to assist you in finding if a Head Start exists in your community. You can also copy and paste this link into your browser to use the Office of Head Start's program locator. https://eclkc.ohs.acf.hhs.gov/hslc/HeadStartOffices

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

Only adults who have custodial rights or guardianship over the child for whom you are applying should be listed here. Please do not include live-in partners who do not have legal rights regarding the child.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Suffix

Nickname

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

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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

Please tell us a little more about your family.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Household

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?

Add Emergency Contact

Use this section to tell us about your child whom you'd like to enroll in our program. If you are a expectant mother wishing to apply for Early Head Start, please complete this section with your information.

First Name (Required)

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

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 your interest in Kidco Head Start and Early Head Start. Please click “submit” to send us your information. Also, please allow 30 business days for us to contact you to schedule an interview appointment.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings