ECEAP Application Prescreen

By completing the Application Prescreen below, you are expressing your interest in the ECEAP program. You will be contacted by an ECEAP staff member to complete the remainder of the ECEAP Application and to verify child's age, Immunizations, Authority to Enroll, Family Size, and Family Income (full list potential of Verification documents

If you have questions while completing the Application Prescreen below, contact Linda Lucas at (509) 323-2720 during regular business hours Monday - Friday 8:00 a.m. to 4:30 p.m.

Complete the 2020-2021 School Year Application Prescreen below. 
ECEAP Prescreen - Step 1

ECEAP Site of Interest:

Enter the site name you are interested in from the ECEAP Location page. 

First Choice: 

Second Choice (if any): 


Child's full legal name (first, middle, last):    

Child's Nickname:      

Child's birth date (mm/dd/yyyy):     Child's Gender Identity:   


IEP - Is this child on an Individual Learning Program (IEP)?   

Yes   No

CPS - Is this child's family currently receiving Child Protective Services (CPS), Family Assessment Response (FAR), or Indian Child Welfare (ICW), or law enforcement/court system regarding child abuse, neglect, or sexual assault? 

Yes  No

Foster Care - Is this child if official foster care? This means there is a caregiver authorization from a state or tribe that says this is a foster care placement?  

Yes   No

Kinship - Is this child in kinship care with a relative or suitable other, with our without a grant? 

Yes   No

Adopted after foster/kinship care - Was this child adopted after foster care, kinship care, or after living in a orphanage in another country (this does not include other adoptions)? 

Yes   No


Housing (select one):  

Rent or own an adequate residence

Doubled-up with another family for convenience, choosing to be close to family or friends, or choosing to save money for future plans

Doubled-up with another family due to loss of housing, economic hardship or similar reason

In an emergency or transitional shelter

Sleeping in a hotel, motel, car, park, campsite or similar location

Moving from place to place (couch surfing)

Inadequate housing such as no water, heat or electricity; excessive mold; no cooking facilities


Language: This child speaks (select only one):

Only English

Mostly English, and some of another home language

Some English, but mostly another home language

English and another language at age level (bilingual)

Only home language other than English

Child's first language:    

Child's second language: 


Is this child Hispanic/Latino?   Yes*   No   

   *If yes, please specify (i.e. Cuban, Mexican, Puerto Rican, Spanish, etc.): 

What race(s) do you consider this child?

White      Black or African American

Alaska Native*   (be specific, i.e. Aleut, Eskimo-Inupiaq or Yupik, Tingit, etc.): 

American Indian*   (be specific, i.e. Colville, Cowlitz, Kalispel, Spokane, Tualip, etc.)

Asian*   (be specific, i.e. Burmese, Cambodian, Chinese, Filipino Japanese, Korean, Mongolian, etc.)

Native Hawaiian or Pacific Islander*   ( be specific, i.e. Fijian, Marshall Island, Native Hawaiian, Samoan, etc.)


Parent/Guardain #1 Name (first and last):    

Parent/Guardian #1 birth date:    

Relationship to child if not biological parent: 

Parent/Guardian #2 Name (first and last): 

Parent/Guardain #2 birth date:   

Relationship to child if not biological parent#2: 

Do you need an interpreter to communicate with English speakers?   

Yes*   No   *If yes, what language(s) do you speak?  

Physical Street Address:  Apt#    City:   Zip code: 

Mailing Address (if different):   Apt #    City:   Zip code: 

Parent/Guardian #1 Email: 

Parent/Guardian #2 Email: 

Parent/Guardian #1 Phone Number:       Parent/Guardian #2 Phone Number: 


Child lives with:

One Parent/Guardian  (Name):  A single parent is a person who lives with a child or children and who does not have a spouse or live-in partner. Reasons for becoming a single parent include abandonment, death of the other parent, childbirth by a single woman or single-person adoption or guardianship/kinship care.

Two Parents/Guardians in same household (make sure both parent names are listed above)

Two Parents/Guardians in two households (if this is checked, answer these questions to determine which parents' income and activities are counted for ECEAP eligibility. Both biological parents need to be listed above.) This includes situations where biological parents are divorces, separated, or broken-up even if not previously married.

Does one household have primary legal custody?   Yes  No

If yes, which parent has primary legal custody?     

Spouse of this parent, if any: 

If no, does one parent receive child support payments from the other household?   Yes   No

If yes, which parent receives the child support payments?    Spouse of this parent, if any: 

If no, ECEAP will count the income from the legal parent/guardian for each household. Do not include their spouses. 

Enter the legal parents' names here: Household 1:   

Household 2 (Name): 

Contact info for Household 2: 

Physical Street Address:   Apt#   City:   Zip: 

Mailing Address (if different):   Apt#   City:   

(be sure to complete the email and phone numbers above for parent/guardian #2)


Household Members: Please count everyone living in the household who may be counted in family size. 

For families temporarily living with relatives or others, do not list the hosts.

For families with two households when there is joint custody with no primary parent and no child support: enter the number of household members for both households, counting only those who are supported financially by parent/guardian and who are related to the ECEAP child's parent/guardian by blood, marriage, or adoption.

If a person is age 19 or older who has earned or unearned income that covers more than half of their expenses, do not include them in the count. 

Staff will use this information to calculate family size to determine federal poverty level.

Number of Household Members in primary household: 

Number of Household Member in second household: 


Parent/Guardian Employment, Training, and Other Activities: Answer the following questions for each parent/guardian named above.

Name of Parent/Guardain #1 

Is parent/guardian #1 emoloyed?   Yes*   No

*If yes, enter number of hours per week in paid work status: 

*If yes, enter employer name and phone number or email: 

Is parent/guardian #1 enrolled and attending school or job training?   Yes*   No

*If yes, enter the total number of hours per week when school is in session. Include class time, up to 10 hours of study time, and travel time:

*If yes, enter name of school or training organization: 

*If yes, enter goal or major: 

Is this parent/guardian #1 in an approved WorkFirst activity other than emoloyment, education or job training mentioned above?

Yes*   No    *If yes, describe activity: 

*If yes, enter number of hours per week in approved activity and related travel: 

Is family approved for child care through CPS, FAR or similar tribal funds?

Yes*   No  *If yes, enter number of approved hours per week: 

Parent #1 is disabled and unable to work and unable to care for the child while the other parent works?*   Yes   No


Name of Parent/Guardain #2 

Is parent/guardian #2 emoloyed?   Yes*   No

*If yes, enter number of hours per week in paid work plus work-related travel: 

*If yes, enter employer name and phone number or email:

Is parent/guardian #2 enrolled and attending school or job training?   Yes*   No

*If yes, enter the total number of hours per week when school is in session. Include class time, up to 10 hours of study time, and travel time:

*If yes, enter name of school or training organization: 

*If yes, enter goal or major: 

Is this parent/guardian #2 in an approved WorkFirst activity other than emoloyment, education or job training mentioned above?

Yes*   No    *If yes, describe activity: 

*If yes, enter number of hours per week in approved activity and related travel: 

Is family approved for child care through CPS, FAR or similar tribal funds?

Yes*   No  *If yes, enter number of approved hours per week: 

Parent #2 is disabled and unable to work and unable to care for the child while the other parent works?   Yes   No


If either parent has more than 55 hours total per week, explain: 


Estimated Family Income

Enter the estimated total annual income received by this child's parent(s) or guardian(s) named above:


How did you find out about ECEAP?

DCYF (formerly DEL) website   Community Event   Flyer   Postcard   ECEAP Employee

Word of Mouth   Caseworker   Media    Community Agency - Name of agency: 

Other - Describe other: 


Survey for statewide planning 

If you could choose the length of day for your child's preschool, which is best for your child and family?

Please note, these options may not all be available in your community this year.

Part-Day - about three  hours, three or four days per week.

School-Day - about six hours, four or five days per week.

Working-Day - available all day (about 10 hours), all year, like a child care center. - Only availble at Green Gable North location, must live in Mead School District, two parents have to work more than 55 combined hours, single parent has to work more than 25 hours. 



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