I verify that the information provided is true and correct. If there are any changes concerning my status, it is my responsibility to contact Early Education and Care, Inc. I understand the information given on this application can be shared for eligibility determination and service referrals to programs operated through the local school district, Head Start, early care and education providers and the Department of Children and Families. I understand that this application is not complete until I have submitted income verification for my child, and that completing this form does not guarantee placement in the above program.
