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Form Submission Successful

Thank you!

You have successfully submitted Start Early’s Healthy Parents & Babies form. Someone will contact you within 48 business hours to review your initial application information and walk through next steps of our full application and enrollment process.

If you have additional questions, please call us at 773-312-7881, or email HPB@StartEarly.org, for further details about this process and our program.

In the meantime, we encourage you to collect the following pieces of information to help speed up the next phase of the application process. 

General Items for all Applicants

  • Proof of pregnancy*: Ultrasound or Pregnancy Verification form/letter
  • Original birth certificate for child(ren)*
  • State ID or driver’s license: Must include your current address
  • Medical card: Provide a copy of your child’s medical card if applying for services for your child, or your personal medical card if applying for pregnancy support services. Benefit letters cannot be accepted.
  • Current physical for your child’s age with labs(lead, TB, hematocrit) *: The physical must be on the State of Illinois form. We will provide the form or you can download the form here.  Physicals can be no more than six months old. Click to see the recommended immunization schedule for children from birth through 18 years old.
  • Employment documentation:
    • If you are employed by an employer: Provide all W2s for each job you held during the previous year (for example if the current year is 2035, provide W2s from 2034) or the transcript or copy of your filed income taxes (last 12 months of income). Or, a filed 1040.
    • If you are self-employed: Provide your currently filed taxes (1040)/IRS Transcript.
    • If you receive unemployment: Provide a recent copy of your unemployment benefits/disbursement.
    • If you receive TANF/SNAP: Provide a recent statement of benefits from the Illinois Department of Human Services indicating your benefit amount for SNAP or TANF Cash.
    • If you receive SSI: Provide a recent statement of Supplemental Security Income.
  • Housing status*:
    • If you are experiencing homeless: Please provide a written statement or document from shelter, a homeless service provider, or from a government child welfare official.
  • Foster care information*: Please provide a Foster Care-Illinois Placement Form 906, Court Order, and/or other legal/government issued document regarding foster care status.

*Items apply to certain family situations