4523 Plank Road Baton Rouge, Louisiana 70805 Phone: 225-358-4504 Intake Section: 225-358-1964
Early Childhood Education - Community Partnership / Volunteerism Nutritious Meals and Snacks - Comprehensive Child and Family Development Services Medical and Dental Services - Social Services for Families Activities for Parents - Assistance for Children with Special Needs
3250 N Acadian Thruway E Baton Rouge, LA 70805 Phone: 225-806-6023 Ages: 18 months-2 years
7200 Maplewood Street Baton Rouge, LA 70812 Phone: 225-355-9776 Pregnant Women and ages 6 months-2 years
9700 Scenic Highway Baton Rouge, LA 70807 Phone: 225-775-7719 Ages: 6 months-2 years
- Applicant’s Birth Certificate/Verification of Birth - Applicant’s Immunization Card (up-to-date) - Notarized proof of guardianship (if applicable) - Social Security Cards for each family member - Applicant’s Medical Card or Health Insurance Card - Verification of Disability (if applicable) - Proof of Income: Relevant Time Period* - Payroll Check Stub (Must have name of company, name of employee, year to date income, hourly pay, pay period) within “Relevant Time Period” - All W2’s for “Relevant Time Period” - Income Tax Return – 1040 (preceding year) - Budget Slip - Social Security Statement - Social Security Income (SSI) Statement - Child Support Documents - Unemployment Compensation - Self-employment Statement - Non-Income Verification or Self-Declaration and Third Party Agreement
(A) the 12 months preceding the month in which the application is submitted; or (B) during the calendar year preceding the calendar year in which the application is submitted, whichever more accurately reflects the needs of the family at the time of application
Federal Law Prohibits Discrimination Because of Race, Color, Religion, Sex, Age, National Origin, and/or Special Needs
Submit copy of Health Insurance Card
Submit copy of medical reports / IFSP relating to Conditions
Optional
I certify that, to the best of my knowledge, the information provided in this application is true and accurate. I understand that if any of this information changes or is found to be incorrect, I am obligated to notify this agency immediately. I understand that falsifying information such as family income, number of children, number of household members or relationship may result in the rejection of this application and my child being terminated from East Baton Rouge Parish Head Start/Early Head Start Program.
* indicates a required field