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Early Head Start Enrollment Form

Please complete this form so that our early childhood team can contact you about getting started with our Early Head Start program:

"*" indicates required fields

MM slash DD slash YYYY
Parent/guardian of an infant or toddler?
Child's name
Child's name
Child's name
Child's name
Adult’s Name
Relationship to Child(ren)
If Mother, are you currently pregnant?
MM slash DD slash YYYY
Check here if family identifies as homeless
Address
Does child's family receive:
Does your child have an active IFSP (Individualized Family Service Plan) from the Regional Center?
How did you hear about LAEP's Early Head Start program?
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Eric Barela, Ph.D.

Senior Consultant, Raya Cooper Impact Consulting

Dr. Eric Barela has worked as a measurement & evaluation professional for over 2 decades, helping organizations to better understand and act on their social impact. He’s currently a Senior Consultant with Raya Cooper Impact Consulting and previously worked at Salesforce, where he led efforts to measure the social impact of the company’s work with nonprofits and educational institutions across the globe. He began his career working with the Los Angeles Unified School District and with the nonprofit, Partners in School Innovation. Eric previously served on the Board of the American Evaluation Association and currently serves on the Editorial Advisory Board of the American Journal of Evaluation.

Eric grew up in East LA and was educated in the Montebello Unified School District. He holds a Ph.D. in education from UCLA. He loves a good road trip, with his husband serving as trusty navigator.