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Head Start Program Application

  1. East Baton Rouge Parish Head Start Program
    4523 Plank Road
    Baton Rouge, Louisiana 70805
    Phone: 225-358-4504
    Intake Section: 225-358-1964
  2. 2017 - 2018 Application
  3. A Tradition of Excellence
    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
  4. Center Locations
  5. Capital Area Early Head Start
    3250 N Acadian Thruway E
    Baton Rouge, LA 70805
    Phone: 225-806-6023
  6. Charlie Thomas Head Start Center
    8686 Pecan Tree Drive
    Baton Rouge, LA 70810
    Phone: 225-761-4436
  7. Child Development and Learning Center
    7315 Exchange Place
    Baton Rouge, LA 70806
    Phone: 225-924-3414
  8. Discovery Head Start Center
    9700 Scenic Highway
    Baton Rouge, LA 70807
    Phone: 225-775-7719
  9. Freeman-Mathews Head Start Center
    1386 Napoleon Street
    Baton Rouge, LA 70802
    Phone: 225-387-8539
  10. LaBelle Aire Head Start Center
    1919 N Cristy Drive
    Baton Rouge, LA 70815
    Phone: 225-275-0426
    Annex: 225-273-6770
  11. New Horizon Head Start Center
    1111 North 28th Street
    Baton Rouge, LA 70802
    Phone: 225-344-2152
    Annex: 225-389-3014
  12. Progress 1 Head Start Center
    1881 Progress Road
    Baton Rouge, LA 70807
    Phone: 225-774-8158
  13. Progress 2 Head Start Center
    1881 Progress Road
    Baton Rouge, LA 70807
    Phone: 225-774-1901
    Additional Phone: 225-774-1939
  14. Wonderland Head Start Center
    1500 Oleander Street
    Baton Rouge, LA 70802
    Phone: 225-346-0677
  15. The following information must be submitted with your application:
    - 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
  16. Relevant Time Period*
    (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
  17. An Equal Opportunity Program
    Federal Law Prohibits Discrimination Because of Race, Color, Religion, Sex, Age, National Origin, and/or Special Needs
  18. Center of Choice
  19. I. Expectant Mother's Information
  20. Parent's Information
  21. Relationship to Child
  22. Race / Ethnicity (Optional)
  23. Parent's Marital Status
  24. Child lives with?
  25. Child's Information
  26. Gender
  27. Race / Ethnicity (Optional)
  28. Language Spoken at Home:
  29. Child's Health Information
    Submit copy of Health Insurance Card
  30. Health Insurance
  31. Emergency Contacts
  32. In case of Emergency Contact
  33. In addition to Emergency Contact, child may be released to:
  34. Medical Conditions / Disabilities
    Submit copy of medical reports / IFSP relating to Conditions
  35. Family Information
  36. Living Arrangement
  37. Housing
  38. Has family moved 2 or more times in the last 12 months?
  39. Transportation
  40. Maternal Relationship
  41. Relationship
  42. Race / Ethnicity
  43. Language:
  44. Education
  45. Employment
  46. Unemployed
  47. Other Public Assistance
  48. Special Conditions / Concerns
  49. Medical Conditions / Disabilities
  50. Health Insurance
  51. Currently Pregnant
  52. Substance Abuse
  53. Physical Abuse
  54. Legal Issues
  55. Paternal Relationship
  56. Relationship
  57. Race / Ethnicity
  58. Language:
  59. Education
  60. Employment
  61. Unemployed
  62. Other Public Assistance
  63. Special Conditions / Concerns
  64. Medical Conditions / Disabilities
  65. Health Insurance
  66. Currently Pregnant
  67. Substance Abuse
  68. Physical Abuse
  69. Legal Issues
  70. Other Family Relationships
  71. Relationship
  72. Relationship
  73. Gender
  74. Gender
  75. Race / Ethnicity
    Optional
  76. Race / Ethnicity
    Optional
  77. Language:
  78. Language:
  79. Education
  80. Education
  81. Relationship
  82. Relationship
  83. Gender
  84. Gender
  85. Race / Ethnicity
    Optional
  86. Race / Ethnicity
    Optional
  87. Language:
  88. Language:
  89. Education
  90. Education
  91. Acknowledgement
    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.
  92. Federal law prohibits discrimination because of race, color, religion, sex, age, national origin, and/or special needs.
  93. An Equal Opportunity Program
  94. Leave This Blank: