Pre-Screening and Enrollment Applications

Universal Pre-Screening Questionnaire

Take the first step in enrolling for services by completing our new Universal Pre-screening Questionnaire,

Click on your preferred language to begin, available in English and Spanish!

Program Applications and Supplemental Documents

Children's Services

Apply for Head Start, Early Head Start, and/or Head Start Mom's Program

Apply Here: https://bit.ly/HSEHSEnroll

Aplicar Aquí: https://bit.ly/HSEHSEsp

• Enrollment Application – English
• Solicitud de Inscripción – Español
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• Enrollment Application for Pregnant Women – English
• Solicitud de Inscripción para Mujeres Embarazadas – Español
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Supplemental Applications

• Enrollment Application Supplement – English
• Solicitud de Inscripción, Anexo– Español‍
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• Enrollment Application Supplement for Pregnant Women – English
• Solicitud de Inscripción para Mujeres Embarazadas, Anexo– Español
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Housing Questionnaire

• Housing Questionnaire – English
• Cuestionario de Vivienda – Español
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Statement of Incapacity

• Statement of Incapacity – English
• Declaración de Necesidades Médicas – Español‍

Community Services

Energy Assistance Programs

• HEAP Application - North and South County (English)
• HEAP Application - North and South County (Spanish)
• HEAP Application - Lompoc Only (English)
• HEAP Application - Lompoc Only (Spanish)
• Income Guidelines 2025‍

Senior Safe At Home

• Senior Safe At Home Application – English

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