Prenatal Early Head Start Application

Please fill out this form to apply for the Early Head Start program. You will need be able to turn in a proof of income and a Birth Certificate or Medicaid/Insurance Card to complete the process of application.


  • Child under 3 years old
  • Pregnant Women
  • Family resides in Utah County
  • Family is low income or the child has a disability

Waiting List

Early Head Start is funded to serve only 164 families at a time. When there is no space available, families are placed on a waiting list in order of need. Risk factors are weighted so that families with more need can move more quickly to the head of the line. We will call families on the wait list when there is an opening in the program.

What happens when you apply?

  • We will call you to set up an Eligibility meeting in which we will collect any needed documentation and review risk factors and needs. After this appointment you will be placed on the waitlist.
  • When there is an opening we will call you and inform you of the potential start date.
  • We will call you to set up your first appointment.

To submit the application:

Click the “submit” button to send your application on-line. You may also print and mail it to us at 475 West 260 North, Orem, 84057.

    Prenatal Mother's Information

    Secondary Adult Information

    Family and Household Information

    Services and Assistance