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  • Early Childhood Programs Application

    Early Head Start / Pregnant Women & Children ages 0-3 and Head Start Children ages 3-5
  • Important**

    Please fill out ONE application PER PERSON. If you are applying for more than one child, you will need to fill out a separate application for each child. If you are a pregnant mother applying for services, and also have a child eligible for Early Head Start, you will need to do two separate applications.
  • If you are a PREGNANT MOM applying for services for yourself, please put "Baby" as the "Child/Applicant Name" above, and the baby's due date as the "birthdate" below.  

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  • Thank you for filling out the Early Childhood Programs application. A Family Service Specialist will be contacting you to complete the application and eligibility process.

  • I, * , certify the information provided in support of this application is accurate and truthful to the best of my knowledge.

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