ERDC Request for more information
This form is to request more information about the Employment Related Daycare Program (ERDC) at Albina Head Start.

Please fill out the following form and a member of our ERDC Team will contact you ASAP. Our goal is to contact you within 1 business day (M-F). If you have not received a response within that time please contact the Head Start or Early Head Start Main Offices.

THIS IS NOT AN APPLICATION FOR ENROLLMENT OR ERDC
IF REQUESTING INFORMATION ABOUT AN APPLICATION THAT HAS ALREADY BEEN SUBMITTED PLEASE CALL ONE OF THE MAIN OFFICES:
HEAD START (503) 282-1975
EARLY HEAD START (503) 236-9389
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What is your current ERDC enrollment status *
Parent/Guardian Full Name (First & Last) *
Phone Number *
E-mail address *
Preferred Method of Contact *
How would you like us to follow up with you?
Best Times to Contact: *
Check all that apply
Child's Full Name (First & Last) *
Child's Date of Birth *
MM
/
DD
/
YYYY
Comments/Questions or any other specific information requested:
Optional
Submit
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