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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: