• Home Visiting Program Child Application

    Kids' Corps, Inc. Home Visiting Program is for expecting families and families with children birth through five years of age. Participants in the program will receive two or four home visits each month with a trained Home Visitor or Parent Educator. Visits include information on development centered parenting (or fetal development and preparing for a new baby), a parent-child activity and resources to improve family well-being. Families are also invited to attend two group connection events each month.
  • What age is the child you are applying for?*
  • Due date: *
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  • Child's Date of Birth:*
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  • Child's Sex*
  • Does your child have any disability or special need? (either diagnosed or suspected)*
  • Do you have concerns about your child’s development?*
  • Does your child have an IEP or an IFSP?*
  • Does your child have a sibling enrolled in the program?*
  • Do you have a 2nd child you want add to the application?*
  • What age is the 2nd child you are applying for?*
  • Due date of child #2: *
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  • Child #2 Date of Birth:*
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  • Child #2 Sex:*
  • Child #2: Does your child have any disability or special need? (either diagnosed or suspected)*
  • Child #2: Do you have concerns about your child’s development?*
  • Child #2: Does your child have an IEP or an IFSP?*
  • Do you have a 3rd child you want add to the application?*
  • What age is the 3rd child you are applying for?*
  • Due date of child #3: *
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  • Child #3 Date of Birth:*
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  • Child #3 Sex:*
  • Child #3: Does your child have any disability or special need? (either diagnosed or suspected)*
  • Child #3: Do you have concerns about your child’s development?*
  • Child #3: Does your child have an IEP or an IFSP?*
  • Primary Parent/Guardian Date of Birth: *
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  • Primary Parent/Gurdian Sex:*
  • Employment Status:*
  • Format: (000) 000-0000.
  • Phone Type:*
  • May we contact you by text message?*
  • Format: (000) 000-0000.
  • Phone Type:
  • Is mailing address the same as physical?*
  • Is there a Secondary Parent/Guardian?*
  • Secondary Parent/Guardian Date of Birth: *
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  • Secondary Parent/Gurdian Sex:*
  • Secondary Parent/Gurdian's Employment Status:*
  • Format: (000) 000-0000.
  • Phone type:*
  • May we contact you by text message?*
  • Format: (000) 000-0000.
  • Phone type:
  • Does Secondary Parent/Guardian share physical address with primary?*
  • Is Secondary Parent/Guardian's mailing address the same as physical?*
  • Parental Status*
  • Family Type*
  • Are you currently a teen parent?*
  • Has your child previously been enrolled in any Kids' Corps program?*
  • Did Primary Parent/Guardian receive the most recent Alaska PFD?*
  • Did Secondary Parent/Guardian receive the most recent Alaska PFD?*
  • Estimated Annual Household Income:*
  • Has your child/ren previously been enrolled in another Early Head Start or Head Start program?*
  • Family Housing Status:*
  • Has your family experienced homelessness in the past 6 months?*
  • Are you currently receiving ATAP and/or SNAP?*
  • Is your family experiencing a special hardship or crisis?*
  • Were you referred by another agency or provider?*
  • How did you hear about KCI?*
  • What is the best way to contact you to follow up on your child's application?*
  • Our Home Based Program has a weekly or bi-weekly home visit schedule. Which is your preference?*
  • Eligibility interviews are required for Early Head start Services. Would you like to complete the eligibility interview in-person or over the phone?*

  • Required Documents

    For Kids’ Corps staff to verify your child’s Early Head Start eligibility, you will need to submit the following documents:

    • Proof of current ATAP or SNAP benefits or
    • Income information for all income sources for a full 12 months (W-2, 1040 tax form, child support, unemployment benefits, ATAP printout, LES, pay stubs, etc.) or
    • documentation that the child is in foster care or the family is currently homeless and
    • A copy of your child’s birth certificate (if available)


    If you have these documents available you can upload them now or scan them to our Enrollment Specialist at miriamPAT@kcialaska.org or drop them at our home visiting office at 101 Davis St. 

    Documents can be submitted before, during or after your eligibility interview.

    If there are barriers to getting the required documents, please let us know and we can assist you.

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