Pregnant Mother Application
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All of the information in this document will be treated confidentially by HCCADC staff.
This form is to be used for pregnant mothers who may be eligible for the Early Head Start Program.
This application does not guarantee acceptance into the programs offered by HCCADC. These programs have income eligibility requirements, which must be verified before a participant can be accepted. After submitting the application, you will be contacted by an HCCADC staff member who will let you know if you may qualify, answer any questions that you may have, and discuss the next steps with you.
The form does not allow you to go back and edit it, please proofread it before submittingÂ