Community Services for Children

Enroll

Our Preschool Programs:

  • Early Head Start Services to pregnant women and infants through age 3
  • Head Start At Home Preschool in your home for children 2 years before kindergarten with health and family services
  • Head Start Preschool for children 1 and 2 years before kindergarten with health and family services
  • Pre K Counts Preschool for children 1 year before kindergarten

How to Apply for One of Our Programs:

  • Application Complete the attached application. If you need any help, please call us at 610-437-6000.
  • Date of Birth Provide a copy of your child’s birth certificate or other document identifying your child’s date of birth.
  • Income Provide documents to verify your household income for the past 12 months. This may include:
    • Pay stubs or unemployment check
    • W2 forms
    • Tax Form 1040
    • A written statement from an employer
    • TANF statement
    • If you are unable to send documentation of your income, please send a signed letter describing your circumstance.
  • Mail or Fax Application and above documents:
    1520 Hanover Avenue, Allentown, PA 18109
    Fax: 610-437-6500 ATTN: Enrollment Department

What Happens Next:

  • Review – Based on the information you give us and eligibility guidelines, we will let you know by mail if you are eligible.
  • Selection – Children are selected for the upcoming school year during the spring. We accept applications year round. When we have an opening for your child, we will contact you to complete the enrollment process.
  • Priority – We prioritize children based on age, income, disabilities and other risk factors that show a high need for services.

Last Name

First Name

Middle Initial

Date of Birth / Estimated Due Date


Age
 Under 1 1 2 3 4 5 1 year before K 2 years before K


Gender
 Male Female


Primary Language
 English Spanish Other
Please specify:


How Well Does Child / Pregnant Mother Speak English
 Not At All Not Well Well Very Well


Family Type
 One Parent Two Parents Foster Relative / Grandparent Other
Please specify:


Living Address

Street Address



City


State


Zip Code


Postal Address

Street Address



City


State


Zip Code


Daytime Caregiver

Home Telephone

Cell Phone

Work Phone

Email

School District / Elementary School


Are you or have you been homeless in the past 12 months?
 Yes No


Housing Type
 Apartment Shelter Temporary / Friend / Family Mobile Home Migrant Housing Hotel / Motel Other


Primary Language
 English Spanish Other
Please Specify:


Best Way to Contact You?
 Phone Mail Email
Best Time to Contact You:


Household Members
Please list all parents, guardians, and children up to age 18 living at the address listed above.

Household Member #1
Parent, Guardian or Child?

Relationship

Birthdate

Race / Ethnicity

Level of Education


Employment Status
 Full Time Part Time Unemployed Not Applicable


Household Member #2
Parent, Guardian or Child?

Relationship

Birthdate

Race / Ethnicity

Level of Education


Employment Status
 Full Time Part Time Unemployed Not Applicable


Household Member #3
Parent, Guardian or Child?

Relationship

Birthdate

Race / Ethnicity

Level of Education


Employment Status
 Full Time Part Time Unemployed Not Applicable


Household Member #4
Parent, Guardian or Child?

Relationship

Birthdate

Race / Ethnicity

Level of Education


Employment Status
 Full Time Part Time Unemployed Not Applicable


Household Member #5
Parent, Guardian or Child?

Relationship

Birthdate

Race / Ethnicity

Level of Education


Employment Status
 Full Time Part Time Unemployed Not Applicable


Community Services Used by Your Family in the Past Year (check all that apply):
 Housing/Section 8 WIC Children and Youth Mental Health / Counseling Services for Child D&A Treatment Corrections/Probation Community Action Turning Point Adult Education/College Family/Individual/Marriage Counseling Family Literacy / ESL Program Other
Please Specify:


Do you have any concerns about your child's development? (check all that apply)
 Physical Development Vision Speech Hearing Behavior Health Other Please describe your concerns
Please describe your concerns:


Does your child have a current IEP?
 Yes No

If yes, please indicate the Early Intervention/IU services your child is currently receiving (check all that apply:
 Speech Development Hearing Language Vision Occupational/Physical Therapy Other
Please Specify:


Do you have another child currently enrolled in:
Head Start
 Yes  No
If yes, location and name of child attending:

Pre K Counts
 Yes  No
Other Preschool
 Yes  No
Subsidized Child Care
 Yes  No
Private Pay Child Care
 Yes  No


Are you or were you a teen parent?
 No Yes
Age of First Pregnancy:


Are you currently pregnant?
 No Yes
Estimated due date:


If you are a pregnant mother, are you currently receiving prenatal care?
 No Yes
If yes, where?

When did your care begin?


Would you be able to provide daily transportation to a center (not all programs offer transportation)?
 No Yes
How?


How did you hear about CSC's Early Childhood and Family Development Programs?

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