Please share your CHILD'S FIRST name. (Please enter "NA" if you are hoping to enroll as a pregnant woman.) *
Your answer
Please share your CHILD'S LAST name. (Please enter "NA" if you are hoping to enroll as a pregnant woman.) *
Your answer
Please share your current HOME phone number. *
Your answer
Please share your current CELL phone number. *
Your answer
Please share an email address for an account you check regularly. *
Your answer
What is the best way to reach you? (Please check all that apply.) *
Required
Which program are you interested in? *
Required
Please enter the CHILD'S current age in YEARS and MONTHS (example, "3 years/7 months"). If a pregnant woman, please enter age in years only (example, "22") *
Your answer
Were you (if a pregnant woman) or your child actively enrolled in the CDI Early Head Start or Head Start program in December 2020? *
Thank you! Someone from our staff will reach out to you very soon. In the meantime, please leave any questions or comments you have here.