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ECEAP Pre Eligibility
ECEAP Pre Eligibility
ECEAP Pre-Eligibility
ECEAP Pre-Eligibility
Now enrolling for the 2024-2025 school year!
Location/Preferences
Which program are you applying for?
*
2024-25 Shelton ECEAP Preschool
2024 – 2025 Lacey/Pleasant Glade ECEAP Preschool
2024 – 2025 Elma ECEAP Preschool
2024 – 2025 Ocean Shores ECEAP Preschool
2024 – 2025 Rochester ECEAP Preschool
Parent/Guardian
Parent/Guardian
*
Parent/Guardian
First
First
Last
Last
Birthdate
*
Gender
Female
Male
Non-binary
Gender
Email
*
Confirm Email Address
*
Phone
*
Race
American Indian or Alaska Native
Asian
Black or African American
Multiracial or Biracial
Native Hawaiian or Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language(s)
Highest Grade Completed
Associates' Degree
Bachelor's Degree
College Degree/Training Certificate
College or Advanced Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or Less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Training or School
Unemployed
Child’s Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Is Your Family Experiencing Homelessness?
No
Yes
Address (Living/Physical)
*
Address (Living/Physical)
Address (Living/Physical)
Address (Living/Physical)
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Is Your Mailing Address the Same as Living Address?
Yes
No
Mailing Address
Mailing Address
Mailing Address
Mailing Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Additional Parent/Guardian
No
Yes
Any other children in the family?
No
Yes
Parent/Guardian
Parent/Guardian
Parent/Guardian
First
First
Last
Last
Birthdate
Gender
Female
Male
Non-binary
Gender
Email
Confirm Email Address
Phone
Race
American Indian or Alaska Native
Asian
Black or African American
Multiracial or Biracial
Native Hawaiian or Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language(s)
Highest Grade Completed
Associates' Degree
Bachelor's Degree
College Degree/Training Certificate
College or Advanced Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or Less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Training or School
Unemployed
Child’s Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Is Your Family Experiencing Homelessness?
No
Yes
Address (Living/Physical)
Address (Living/Physical)
Address (Living/Physical)
Address (Living/Physical)
City
City
State/Province
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State/Province
Zip/Postal
Zip/Postal
Is Your Mailing Address the Same as Living Address?
Yes
No
Mailing Address
Mailing Address
Mailing Address
Mailing Address
City
City
State/Province
State/Province
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Additional Parent/Guardian
No
Yes
Family Information
Number of Parents/Guardians in Household
One-Parent Family
Two-Parent Family
Relationship to Participant(s)
Foster Parent(s) (not including relatives)
Grandparent(s)
Other
Parent(s) (e.g. biological, adopted, step parents)
Relative(s) (other than grandparents)
Primary Language at Home
Is Another Language Being Acquired or Learned at Home?
No
Yes
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
No
Yes
Is your family receiving Supplemental Security Income (SSI)?
No
Yes
Is your family receiving services from WIC?
No
Yes
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
No
Yes
Is at least one parent/guardian an active duty member of the United States military?
No
Yes
Is at least one parent/guardian a veteran of the United States military?
No
Yes
Siblings
Name
Name
First
First
Last
Last
Birthdate
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Hispanic
Yes
No
English Proficiency
Little
Moderate
Other Language(s)
Emergency Contact
Name
*
Name
First
First
Last
Last
Relationship to Participant
May we contact this person if we are unable to reach you?
Yes
No
May we release your child to this person?
Yes
No
Phone
*
Do you want to include an alternate emergency contact?
No
Yes
Emergency Contact
Name
Name
First
First
Last
Last
Relationship to Participant
May we contact this person if we are unable to reach you?
Yes
No
May we release your child to this person?
Yes
No
Phone
Child/Participant Information
Name
*
Name
First
First
Last
Last
Birthdate
*
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Hispanic
Yes
No
English Proficiency
Little
Moderate
Other Language(s)
Primary Healthcare Coverage
Medicaid
No Insurance
Other
Private Health Insurance
Doctor/Medical Clinic
Dentist/Dental Home
Is there anything else you want to tell us about your child?
Do you want to apply now for another child in your family?
No
Yes
Child/Participant Information
Name
Name
First
First
Last
Last
Birthdate
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Hispanic
Yes
No
English Proficiency
Little
Moderate
Other Language(s)
Primary Healthcare Coverage
Medicaid
No Insurance
Other
Private Health Insurance
Doctor/Medical Clinic
Dentist/Dental Home
Is there anything else you want to tell us about your child?
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