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Head Start/ECEAP/Early Head Start Initial Applicationadmin2025-07-10T13:47:06-07:00

Head Start/ECEAP/Early Head Start Initial Application

Thank you for your interest in our program for young children. Please complete the following form to continue the application process.

Step 1 of 6 - About Your Child

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  • This field is hidden when viewing the form
    Field used to track if applicant reached site via a recruitment event

  • Initial Application

  • To complete this application, you will need to upload the following documents at the end:


    • Age Verification (Birth Certificate, Passport, etc.)
    • Income Verification (W-2, 1040, TANF, SSI/SSDI, etc.)
    • Basic Food/SNAP award letter
    • Working Connections Child Care (WCCC) award letter

    Please upload these documents at the end of the application.

  • Select all that apply

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  • Part Day, School Day, or Extended Day?

  • About Your Child

  • Select all that apply.
  • e.g. Molina, Community Health Plan
  • This means there is a caregiver authorization form from a state or Tribe that says this is a foster care placement. (Please attach the Foster Authorization Form and grant.)
  • (i.e. Lummi Nation Head Start, Nooksack Tribal Head Start, etc.)
  • ELAFS serves children with behavior issues. Checking yes will not exclude your child.

  • Previous Enrollment

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  • Parent/Guardian #1

  • Select all that apply.

  • Parent/Guardian #2

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  • Housing

  • select one
  • *Homelessness refers to a state in which individuals lack a fixed, regular, and adequate nighttime residence, including children who are sharing housing of other persons due to loss of housing, economic hardship, or similar reason (living in motels, hotels, trailer parks, or camping grounds owing to a lack of alternative adequate accommodations; living in emergency or transitional shelters, or abandoned in hospitals, cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations). Homelessness may apply to migrant children under certain circumstances. NOTE: This is a definition used by federal, state, and local educational institutions (e.g., Head Start, Child Care, IDEA Part C and Part B, etc).

  • About Your Family

  • select all that apply
  • Child Protective Services (CPS)- CURRENT
  • Child Protective Services (CPS)- PREVIOUS
    • Please list everyone living in the household who may be counted in the family size.
    • For families temporarily living with relatives or others, do not list the hosts.
    • For families with two households when there is joint custody with no primary parents and no child support:
      • Enter the household members for both households in the table below.
      • Mark members of the second household.
      • Then, answer the questions about financial support and relationships.
  • Include all family members not already listed above. Staff will use this information to calculate family size to determine Sate Median Income (SMI)
    First NameLast NameDate of BirthRelationship to Applicant ChildDoes the Applicant child’s parent/guardian financially support this person? **Is this person related to the Applicant child’s parent/guardian by blood marriage, or adoption?What race(s) do you consider this person?What language(s) does this person speak? 

  • **Answer “No” for a person age 19 or older who has earned or unearned income that covers more than half of their expenses.
    **Answer “Yes” if the applicant child’s parents pay more than half of their expenses.

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  • First Parent/Guardian Employment and School History

  • Please enter where your are working/studying, and for each day, the time you start work, and the time your day ends. For example "8:00am to 5:00pm". You may leave days you don't work blank.
    Answer the following questions for each parent/guardian listed:
    Do not count the same hours in more than one category. For example:
    • Do not count the same hours of the week in both employment and WorkFirst.
    • Do not count the same CPS child care hours separately for two parents.
      WorkplaceMonTueWedThuFriSatSun 
    • Answer the following questions for the first parent/guardian listed:
      Do not count the same hours in more than one category. For example:
      • Do not count the same hours of the week in both employment and WorkFirst.
      • Do not count the same CPS child care hours separately for two parents.
    • Please enter a number less than or equal to 10.
    • Please enter a number less than or equal to 10.
    • This field is automatically calculated from average paid hours, class hours, study hours (max 10), travel time (max 10), and WorkFirst hours; if the total is 55 or more, please explain your schedule.
    • Please briefly explain why your schedule is more than 55 hours per week.

    • Second Parent/Guardian Employment and School History

    • Please enter where your are working/studying, and for each day, the time you start work, and the time your day ends. For example "8:00am to 5:00pm". You may leave days you don't work blank.
      Answer the following questions for each parent/guardian listed:
      Do not count the same hours in more than one category. For example:
      • Do not count the same hours of the week in both employment and WorkFirst.
      • Do not count the same CPS child care hours separately for two parents.
        WorkplaceMonTueWedThuFriSatSun 
      • Answer the following questions for the second parent/guardian listed:
        Do not count the same hours in more than one category. For example:
        • Do not count the same hours of the week in both employment and WorkFirst.
        • Do not count the same CPS child care hours separately for two parents.
      • Please enter a number from 0 to 10.
      • Please enter a number less than or equal to 10.
      • This field is automatically calculated from average paid hours, class hours, study hours (max 10), travel time (max 10), and WorkFirst hours; if the total is 55 or more, please explain your schedule.
      • Please briefly explain why your schedule is more than 55 hours per week.

      • Special Needs

      • (No IEP, diagnosis, or screening, or completed developmental screening with result, "rescreen needed."

      • Health and Social Services Information

      • Select all that apply
      • Select one
      • Select all that apply
      • Select all that apply
      • Select all that apply
      Save and Continue Later

      • Circumstances You Would Like to Share

        This may qualify you for additional program supports.
      • This may qualify you for additional program supports.

      • Certification

      • I promise that the information on this form is true and correct. I have authority to enroll this child and have reported all my income and family size, as required by ECEAP/HS/EHS. If I knowingly provide false information, I understand my family may be unable to continue services. Additionally, I may have to repay the amount spent on my child’s services. I understand that information from this application is entered in the Early Learning Management System (ELMS) operated by the Department of Children, Youth, and Families (DCYF). DCYF is committed to protecting confidential and personal information that could identify a child or family. No information related to immigration status is entered into ELMS or shared with state or federal agencies. Information in ELMS may be used for:
        • Research studies to determine if participating in ECEAP helps children later in life.
        • To prove Washington State spends some of their own dollars on programs for families, which is required to receive Temporary Assistance for Needy Families (TANF) dollars from the federal government.
      • MM slash DD slash YYYY

      • Optional - Verification of Age and Income File Upload

        If scanned copies are unavailable, Verification of Age and Income can be mailed or submitted in person. Your application will not be complete until all items have been received.
      • Please black out your SSN before uploading
        Max. file size: 30 MB.
      • Please black out your SSN before uploading
        Max. file size: 30 MB.
      • Either the last 12 months or the last calendar year.
        Max. file size: 30 MB.
      • Either the last 12 months or the last calendar year.
        Max. file size: 30 MB.
      • Birth Certificate or Hospital Certificate
        Max. file size: 30 MB.
      • Basic Food/SNAP Award Letter from DSHS
        Max. file size: 30 MB.
      • If the child has an Individualized Education Plan (IEP) you can upload it here
        Max. file size: 30 MB.
      • This field is for validation purposes and should be left unchanged.
      Save and Continue Later
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