ehs-application@montgomerycountymd.gov
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Please read this important information before applying.
Only complete applications will be reviewed. Complete applications must include include all required documentation below. Please have all documents ready before you apply.
1. Proof of income. Acceptable documentation includes pay stubs, 2021 state or federal tax returns, unemployment, social security, or other benefit letters or statements.
2. Proof of residency. Acceptable documentation must include your full name and the address where you live, such as utility bills, voter registration cards, leases, or mortgage payments. If you do not have those, your landlord or the property owner may prove your residency with a letter. Letters must come with a utility bill, lease, or mortgage payment that show your address and the landlord or property owner's name to be accepted.
3. Proof of relationship. Acceptable documentation must prove relationship to the children on your application, such as a birth certificate, or guardianship or custody papers.
4. (If applicable) Proof of enrollment. This only applies if your child(ren) attend Early Head Start at any of the County's three locations:
CentroNia at 1345 University Blvd East, Takoma Park, MD 20912 Lourie Children's Center at 12301 Academy Way, Rockville, MD 20852 Family Services Inc. at 620 East Diamond Ave, Gaithersburg, MD 20877
Please remove any social security numbers if they are on any documentation.
Parent Full Name
Parent Date of Birth
Parent Gender
Ethnicity (For Reporting Purposes Only)
Please fill in the address where you currently live.
Do you have a spouse or partner who lives with you in your home?
How many children do you have who currently live with you?
Spouse/Partner Full Name
Spouse/Partner Date of Birth
Spouse/Partner Gender
Child 1 - Full Name
Child 1 - Date of Birth
Child 1 - Gender
Are you applying for Head Start for this child?
Is Child 1 in foster care?
Is Child 1 in the Infants and Toddlers Program?
Child 2 - Full Name
Child 2 - Date of Birth
Child 2 - Gender
Is Child 2 in foster care?
Is Child 2 in the Infants and Toddlers Program?
Child 3 - Full Name
Child 3 - Date of Birth
Child 3 - Gender
Is Child 3 in foster care?
Is Child 3 in the Infants and Toddlers Program?
Do you have another child who lives with you?
Child 4 - Full Name
Child 4 - Date of Birth
Child 4 - Gender
Is Child 4 in foster care?
Is Child 4 in the Infants and Toddlers Program?
Child 5 - Full Name
Child 5 - Date of Birth
Child 5 - Gender
Is Child 5 in foster care?
Is Child 5 in the Infants and Toddlers Program?
Community Based Head Start currently has four (4) childcare partners for the 2023-2024 school year, which are listed below.
Please select up to three (3) childcare providers on your application and rank them.
We want all families to feel comfortable with their choice of childcare provider, so we will make every effort to match your child to your first choice provder. If that is not possible, we will make every effort to place your child at the second or third choice provider you select.
Please do not upload your license or any documentation containing a social security number to this application.
Upload File(s) - Proof of Income - Household Income Verification - Last 30 days (If unemployed - upload last paystub or unemployment information) - If paid in cash write a self-declaration of earned income and upload.
Upload File(s) - Proof of relationship - Child(ren) Birth Certificate(s)
Upload File(s) - Proof of Residency - Lease or Rental Agreement or Utility Bill
Upload File(s) - Proof of Enrollment - Proof of enrollment is required only for the children who: Currently attend Early Head Start at one of the three locations on the application AND You want to enroll them in Head Start
