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  • Application

  • For This Application To Be Considered, Please Include The Following:

    -->Child's Date of Birth and/or Proof of Pregnancy (if pregnant, and applying for Prenatal Services) AND

    --> Last year's income (for both parents in the home) Tax return (must be signed), or copies of all W-2's, or a letter from DHS or Unemployment. 

    Services for Teen Parents are provided through partnership with Portland Public Schools. If you are a teen parent attending or planning to attend PPS, please email ehsfrontdesk@albinaheadstart.org or call 503-236-9389 to obtain information prior to completing this application.

    • Number of Children 
    •  / /
    • One Child 
    •  / /
    • Second Child 
    •  / /
    • Third Child 
    •  / /
    • Parent(s) / Guardian Information 
    •  / /
    • Second Parent/Guardian 
    •  / /

    • Income / Eligibility Information

      FAMILY means all persons living in the same household who are supported by the child's parent(s) or guardian(s) income; and are related to the child's parent(s) or guardian(s) by blood, marriage, or adoption; or are the child's authorized caregiver or legally responsible party.

      Please call 503-282-1975 or 503-236-9389 if you have questions.

    • Homeless is defined According to section 725(2) of the McKinney-Vento Homeless Assistance Act (42 U.S.C. 11434a (2, the term "homeless children and youths" (A) means individuals who lack a fixed, regular, and adequate night time residence; and (B) includes (i) children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative accommodations; are living in emergency or transitional shelters; are abandoned in hospitals; or are awaiting foster care placement; (ii) children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings; (iii) children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and (iv) migratory children who qualify as homeless for the purposes of this subtitle because the children are living in circumstances described in clauses (i) through (iii Children and youth are considered homeless if they fit both part A and any one of the subparts of part B of the definition above.

    •    
      Early Head Start Options 
      Please number (1, 2, 3) beside your top three location preferences. We cannot guarantee you a spot at your chosen sites, we will try to accommodate your request.

      *Sites with both EHS and HS are Blank, Brown, McCormack, PCC and Young.
      Infant Classrooms are located at Blank, Brown, Gordly, McCormack, PCC, Talton (Faubion).
      PPS Teen Sites for Infant/Toddler are located at the following high schools: Grant, Roosevelt, Franklin, Marshall and McDaniel Early Head Start Center Based.

      Blank, Owen: 909 NE 52nd 
      Brown, Richard: 605 NE Ivy 
      Clarendon: 9325 N Van Houghton 
      Franklin High School: 5405 SE Woodward  
      Gordly, Avel: 911 N Skidmore  
      Grant High School: 2245 NE 36th 
      Highland 7600 NE Glisan
      McCormack Matthews*: 6930 N Kerby
      Hayu Alqi Uyxat PPS 01: 1530 NE Glisan
      McDaniel High School: 2735 NE 82nd Ave
      PCC SE Campus (PCC Students)
      Roosevelt High School: 6941 N. Central
      Rose, Traci: 4206 NE Garfield
      Talton, Carl (Faubion): 2930 NE Dekum
      Young, Carolyn*: 4219 NE MLK Jr.
            

    • Early Head Start Options
      Please select your top three location preferences below. We cannot guarantee you a spot at your chosen sites, we will try to accommodate your request.

      *Sites with both EHS and HS are Blank, Highland, McCormack, PCC SE, PCC Cascade and Young.


      Infant Classrooms are located at Blank, Brown, McCormack, PCC SE, PCC Cascade, Talton (Faubion).


      PPS Teen Sites for Infant/Toddler are located at the following high schools: Grant, Roosevelt, Franklin, Hayu and McDaniel Early Head Start Center Based.

    • Head Start Options
      Please select your top three location preferences below. We cannot guarantee you a spot at your chosen sites, we will try to accommodate your request.

      *Sites with both EHS and HS are Blank, McCormack, PCC SE, PCC Cascade and Young.

    • Head Start Options 
      Please number (1, 2, 3) beside your top three location preferences. We cannot guarantee you a spot at your chosen sites, we will try to accommodate your request.

      *Sites with both EHS and HS are Blank, Brown, McCormack, PCC and Young.

      Angelou, Maya: 4010 N Borthwick
      Lewis, Charlotte: 4919 NE 17th (Mandarin Instruction Included)
      Carlton Court: 5249 NE Killingsworth
      Clegg, Tina: 1425 NE Dekum (Mandarin Instruction Included)
      Garlington, Yvonne & John: 4514 SE Flavel Dr. 
      Highland*: 7600 NE Glisan
      Lexington Court: 7858 SE 72nd
      McCormack Matthews*: 6930 N Kerby (Mandarin Instruction Included)
      PCC SE Campus Must be PCC Student
      Priestley, 6841 N Interstate
      Sylvia, Audrey: 241 N Alberta
      Waters, Gladys: 111 NE Failing (Mandarin Instruction Included)
      Young, Carolyn*: 4219 NE MLK Jr.

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      I certify this information is true, if any part is false, my participation in the agency's programs may be terminated and I may be subjected to legal action. I hereby consent and agree to disclosure by Albina Head Start of the information provided and included with this application, or any summaries thereof or prepared or obtained by Albina Head Start, to any third party in connection with verification of the information provided, the eligibility of the child to receive services from Albina Head Start, or Albina Head Start's eligibility to participate in or take advantage of federal, state, or local programs.

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