ECS Head Start Application

Eligibility Disclaimer
Please read the following carefully before continuing.

For your child to be eligible for ECS Head Start, one or more of the following must be true,
- I receive public assistance, like TANF/CalWorks, SSI, SNAP/CalFresh
- I am experiencing an inadequate living situation
- I am participating in foster/kinship care
- My income is below the Federal Poverty Guidelines
💡Still unsure? Click here to learn more about your eligibilitiy!

Documents Required
Please have the following documents available.

1. Child’s proof of age (birth certificate, court documents, foster documents, etc.)

2. One (1) of the following [Only if applicable to you]

3. One (1) Proof of Income [Only if above statements are not applicable]

4. IEP or IFSP [If applicable]

5. Proof of Pregnancy [If applicable]

Language Preference
What is your preferred language?*

Ayuda en español
Si desea completar la aplicación en español,
1. Haga clic en el botón English (US) en la parte superior derecha de la página,
2. Seleccione Español.

Housing Information
Are you currently experiencing a lack of fixed, regular, and/or adequate nighttime residence?*

YesNo
If No, please select from the following housing types*
Living Address*

Street Address

Apt/Unit/Suite

CityState

Zip Code
Mailing Address (If applicable)

Street Address

Apt/Unit/Suite

CityState

Zip Code

Living Arrangements Self-Declaration
Type of living arrangement*
Please list the following as it applies to your living arrangement*
Living Arrangement(s)
Length of time in living arrangement*
I authorize ECS Head Start staff to contact a third party for living arrangements verification if no other valid form verification is provided*

YesNo
Name of third party *

First NameLast Name
Phone Number of third party*
Please enter a valid phone number.
Eligibility Self Declaration Verification
Comments
Validated by:

First NameLast Name
Date of Validation

MonthDayYear
Date

Child Support Self-Declaration
Have you received child support in the last 12 months?*

YesNo
If no, please provide an estimated start date*

MonthDayYear
Date
Amount received monthly*
Is the child support received your only source of income?*

YesNo
What source of funds do you use to pay for food/rent/utilities?*
I authorize ECS Head Start staff to contact parent/guardian providing child support*

YesNo
Parent/guardian providing child support*

First NameLast Name
Phone number*
Please enter a valid phone number.
Eligibility Self Declaration Verification
Validated by Third PartyAttempted but Unable to ValidateOther
Comments
Validated by:

First NameLast Name
Date of Validation

MonthDayYear
Date

Additional Family Members

Additional family members include family members residing in the home related by blood, marriage, or adoption and who are supported by the income of the parent/guardian.
Are there additional family members in the home?*

YesNo

Emergency Contact

You must provide at least one (1) emergency contact.

Upload Documents
Immunizations

California schools and child care programs are required to verify immunization records before school entry. All immunizations must be met before your child can attend our program. You will be asked to provide a copy of your child's current immunization record prior to their first day of school.
IFSP / IEP

We require proof of Family Service Plan (IFSP) or Individual Education Plan (IEP) for your child.
Upload IFSP / IEP document(s) here:

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Proof of Pregnancy
Upload Proof of Pregnancy document(s) here:

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Proof of Age

We require a document to confirm the child's age and identification. Please upload one (1) of the following documents:
- Birth certificate
- Foster documents
- Court documents
Upload Proof of Age document(s) here:

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Upload only one (1) of the following
SNAP / CalFresh
- Picture of your EBT card (front and back),
- Phone screenshot of Active status,
- Notice of Action.
TANF / CalWorks
- Phone screenshot of Active status,
- Notice of Action
Foster/Kinship Care
- Foster-parent agreement,
- County Forms,
- Guardianship documents.
Supplemental Security Income
- Notice of Change in Payment,
- Phone Screenshot of Active status.
Proof of Income
- 30 days of consecutive paystubs,
- Unemployment documents,
- Previous years' 1040 tax form,
- Previous years' W-2 form.
Upload your Income/Categorically Eligible document(s) here:

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Proof of Income not required at this moment

You indicated that you and your family are experiencing a lack of fixed, regular, and/or adequate nighttime residence. We will use the third party information shared to verify this. At this moment, you do not need to submit proof of income.
Upload a copy of the Returning Applicant Update Form

The form must be initialed, signed, and dated by the parent/guardian.
Returning Applicant Update Form:*

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Certification Statement
Please read the following carefully.

I certify that this information is true. If any part is false, my participation in this agency’s programs may be terminated. I also understand that the information in this application will be held in strict confidence within the agency and is accessible to me during normal business hours. I also certify I was not encouraged, advised or influenced to do any of the following:
- Misrepresent, alter documentation, or not be truthful about my income
- Misrepresent, alter documentation, or not be truthful about my household size or living arrangements
- To misrepresent, alter documentation or not be truthful about any other situation that would impact my eligibility or participation in the program
- I also understand and authorize ECS Head Start staff to seek verification from person(s) named in this application to determine eligibility for this program
As stated at the bottom of the Returning Applicant Update Form

I understand that if my child is eligible to return based on the ECS priority selection, a slot will be reserved for my child for up to five dats after school starts. The option or site requested may not be available.

Entiendo que si mi hijo(a) es elegible para regresar basado en la seleccion de prioridad de ECS, se reservara un espacio para mi hijo(a) hasta cinco dias despues del inicio de la escuela. Es posible que la opcion o el centro solicitado no este disponible.
Please type your name to complete Certification.*

First NameLast Name
(For ECS Employee to fill) Please type your name to complete Certification.
Parent Signature Date*

MonthDayYear
Date
ECS Staff Name*

First NameLast Name
Site Supervisor*

First NameLast Name
Site Supervisor Email*
example@example.com
💡 The Site Supervisor will receive a copy of the Returnee Application once submitted.
Staff Location*
How did you hear about ECS Head Start? (v2)
Today's Date*

MonthDayYear
Date
How did you hear about ECS Head Start?*
Eligibility Determination Summary
Child's/ Pregnant Applicant Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Primary Parent/Guardian
Secondary Parent/Guardian
Documents Used for Verification
Number Of Adults
Number Of Children
Total Annual Income
Age Eligible?
ECS Priority Level
Based on this information, this family is:
Reviewed By:

First NameLast Name
Signature

Clear
Date
Should be Empty:

Eligibility Disclaimer

Documents Required

Language Preference

Ayuda en español

Start your Application

Contact Information

Application Transmittal Form

Eligibility Information

Center/ Options for 2026 - 2027 School Year

🔎 Explore our ECS Head Start Locations

Additional Pregnancy Information

Child Information

2nd Additional Child Information

3rd Additional Child Information

Housing Information

Living Arrangements Self-Declaration

Family Information

Family Type Information

Child Support Self-Declaration

Primary Parent/Guardian Information

Employment Information

Benefits Information

Previous Employment Information

Secondary Parent/Guardian Information

Employment Information

Benefits Information

Previous Employment Information

Additional Family Members

Emergency Contact

Upload Documents

Certification Statement

Eligibility Determination Summary