APPLICATIONS WILL NOT BE ACCEPTED WITHOUT COPIES OF THE FOLLOWING DOCUMENTATION
1. A form of legal documentation to prove the child’s age:
birth certificate, hospital record or Medicaid/AR Kids card
2. Household income verification for the past twelve months:
One month of check stubs, tax returns, W-2s, employer statements, TEA, Child Support, Social Security, SSI, Unemployment, Veterans Benefits, SNAP, WIC, etc. Household income includes all means of support for the last twelve months from all parents/guardians of the child who also live in the same household as the child.
If the child has a diagnosed disability, documentation relating to the disability must be provided along with this application.
If your child is accepted for enrollment in one of our programs, then you will be asked to supply copies of the following documentation (you may also provide these documents now in order to expedite the enrollment process):
1. State birth certificate or hospital record
Applications for Arkansas state birth certificates are available from F.A.C.T., Inc. upon request.
2. Immunization Record
Shots must be current according to the age of the child. Check with your physician or local health clinic.
3. Medicaid Card/AR Kids or Private Insurance (if applicable).
Medicaid/AR Kids applications are available upon request.
Should you have any questions regarding the required information, please contact the ERSEA Coordinator at (870) 862-4545 or your local center.