Early Childhood Enrollment Applications

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EARLY CHILDHOOD PROGRAM APPLICATION

PRENATAL EARLY HEAD START APPLICATION

Things to bring for enrollment:

• Proof of Income
  (i.e. Pay stubs, W-2 form, 1040 tax form, child support information, social security benefits, unemployment information, written statement from employer)
   
• Copy of any legal custody/guardianship papers
  (if applicable)
   
• Proof of Medical Insurance for child applying
  (i.e. Private insurance, Ohio Medicaid/Healthy Start) (if applicable)
   
• Copy of the applying child’s birth certificate
   
• Copy of the applying child’s social security card
   
• Copy of the applying child’s immunization record
  (If you cannot locate a copy of your child’s immunization record, please complete a release form with our office.)