Our Mission
To improve the quality of life to our customers by:

  - Enhancing economic well-being
  - Strengthening families
  - Coordinating services
  - Promoting equity

Our Core Values
Respect, Responsibility and Professionalism

You are here: Home > How to Apply? > Application Requirements

Application Requirements

Here are some helpful reminders in completing a Healthy Start application.


Statement of Income from work or wages
___ For family members who are employed, please provide four (4) recent pay stubs OR a letter from your employer stating the days, hours and rate of pay they receive on business letterhead stationery. The letter must have been written within the last 30 days before application.

Proof of Pregnancy (if applicable)
___ A pregnant woman must submit a statement verifying their pregnancy written by a doctor or a nurse. The statement must include the expected date of the child's birth and the number of unborn babies; twins = 2 babies.

Identity Documents
Each household member applying for Healthy Start must provide verification of their identity.
___ Household members over 18 years old must submit a copy of a state-issued driver's license or state ID, government issued ID or Military ID or record.
___ Household members between 16-18 years old must submit a copy of a school ID (with photo) or state issued ID.
___ Household members under 16 years old must submit a school record or report card or a childcare or nursery school record or an affidavit from their parent. This affidavit is subject to penalty for perjury.

Citizenship Documents
___ Each household member must submit verification of citizenship to qualify for Healthy Start. Each member must submit either a copy of their U.S. Passport or Naturalization Certificate or an original birth certificate with a copy of identification such as a Driver's License or State-issued I.D. These documents can either be verified and copied at your local Neighborhood Family Service Center or returned to you using certified mail.

Other Health Insurance
___ If any household member applying for Healthy Start has medical coverage through any other health insurance plan, they will need to submit a copy of the insurance card or other proof of coverage. (Please be sure to copy both sides of the insurance card.)

Application Details
___ Applicants must sign and date the application form.
___ Applicants must review, sign and date the Rights and Responsibilities form and return with the application.

Application Submission
Once the application is completed, signed and dated it may be submitted by: