[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-277197-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-277197-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","pregnant-womans-application-confidential","PREGNANT WOMAN’S APPLICATION - Confidential","","Pregnant Woman’s Application (Confidential) for Child and Family Development Programs, detailing eligibility requirements and intake steps for women residing in Santa Cruz County. It covers income and categorical (automatic) eligibility criteria, required documentation such as income records and pregnancy verification, and submission options in person or by mail. The form also collects household, pregnancy verification, service coverage, referrals, and program communication preferences for confidential processing and waitlist prioritization using selection criteria.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/pregnant-womans-application-confidential/277197/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/pregnant-womans-application-confidential/277197.png","ImageObject",442,249,{"name":42,"@type":43},"\tJames","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-28","2026-09-15",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What eligibility requirements must be met for the Pregnant Woman program?","Question",{"text":63,"@type":64},"Eligibility is based on meeting current year Federal Poverty Guidelines through income or qualifying for categorical (automatic) eligibility. Categorical eligibility includes receiving CalWORKs benefits, having a supported household member receiving SSI, or meeting the McKinney-Vento homelessness definition.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What documents are required to determine eligibility?",{"text":68,"@type":64},"Submit the completed application with copies of income documents and pregnancy verification, including a letter from a doctor and/or an ultrasound printout. Processing will not occur without these documents.",{"name":70,"@type":61,"acceptedAnswer":71},"How can the application be submitted, and how is information handled?",{"text":72,"@type":64},"The application can be submitted in person or mailed to the listed address. All information is kept confidential and is used to determine eligibility and prioritize placement on the wait list.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},277197,1790160145,{"code":4,"msg":82,"data":83},"success",[84,89,94,98,103,108,112,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":90,"doc_module":22,"doc_module_name":25,"category_name":91,"show_sort_weight":92,"slug":93},12,"Resumes",80,"resumes",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":30,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},2336474466412,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Child and Family Development Programs  \nEarly Head Start/Head Start/State Pre-K  \n225 Westridge Drive, Watsonville, CA 95076  \nOffice: (831)724-3885/(831)688-3802 Fax: (833)204-4892 Email: [ERSEAIntakeApplication@EncompassCS.org](ERSEAIntakeApplication@EncompassCS.org)  \nThank you for your interest in our Pregnant Woman program. Our high quality Pregnant Woman program is available to women living in Santa Cruz County. To qualify for our services you must be income or categorically eligible.  \nIf you have any questions about the application, or documents required, or need assistance in completing this application, please let us know. We will be happy to assist you!  \nIncome Eligibility  \n􀁸 You are eligible if your income meets the current year Federal Poverty Guidelines.  \nCategorical (automatic) Eligibility  \n􀁸 If you are receiving benefits or services through the CalWORKs program OR  \n􀁸 A family member living with and supported by you is receiving Supplemental Security Income (SSI) OR  \n􀁸 The family considers themselves homeless (per the definition of the McKinney-Vento Homeless Act).  \nRequired documents to determine eligibility  \nPlease submit your completed application with copies of the following documents (document will not be returned):  \n􀁸 Income documents: Documents must include all sources of income received by you and spouse/partner (see income Eligibility section of application for more detailed information).  \n􀁸 Pregnancy verification: Letter from doctor and/or ultrasound printout.  \n(Note: Your application will not be processed without the above documents)  \nSubmitting your Application  \nAll information is kept confidential. The information you provide us will assist us in determining if you’re eligible for our Pregnant Woman program and to prioritize (using our selection criteria point system) your placement on the wait list.  \nYou can submit your application in person or mail it to the address above. Our Intake Staff will contact you regarding your application.  \nCFDP Child Development Programs does not discriminate against children or families on the basis of race, color, national origin, gender religion, age disability, political beliefs, sexual  \norientation, and marital or family status.  \nChild and Family Development Programs  \nEarly Head Start/Head Start/State Pre-K  \n225 Westridge Drive, Watsonville, CA 95076  \nOffice: (831)724-3885/ (831)688-3802 Fax: (833)204-4892 Email: [ERSEAIntakeApplication@EncompassCS.org](ERSEAIntakeApplication@EncompassCS.org)  \nPREGNANT WOMAN’S APPLICATION  \n(Confidential)  \n\n| How did you hear about our program (√)? |\n| --- |\n| □ Friend of Family □ Community Agency □ Community Event □ Print Advertisement □ Internet □ Other:   |\n\n\n| PREGNANT WOMAN’S INFORMATION |  |  |  |  |\n| --- | --- | --- | --- | --- |\n| First Name: |  | Last Name: | Birth Date: | Language spoken at home? |\n| Home Address: |  |  | City/Zip Code: |  |\n| Mailing Address: |  |  | City/Zip Code: |  |\n| Home Phone \\#: | Cell Phone \\#: |  | Email address: |  |\n| □Married □Single □ Divorced □Separated □Widow |  |  | Occupation: |  |\n| Are you currently in the United States military?\u003Cbr>□ Yes □ No |  |  | Are you an employee of Encompass Community Services (√)?\u003Cbr>□ Yes □ No If yes, which program? |  |\n| Are you related to an employee of this program/agency (√)?\u003Cbr>□ Yes □ No If yes, who? |  |  | In what language do you prefer written materials (√)?\u003Cbr>□ English □ Spanish |  |\n| SPOUSE/PARTNER’S INFORMATION |  |  |  |  |\n| First Name: |  | Last Name: | Birth Date: | Language spoken at home? |\n| Home Address: |  |  | City/Zip Code: |  |\n| Mailing Address: |  |  | City/Zip Code: |  |\n| Home Phone \\#: | Cell Phone \\#: |  | Email address: |  |\n| Occupation: |  |  | Are you related to an employee of this program/agency (√)?\u003Cbr>□ Yes □ No If yes, who? |  |\n| Are you currently in the United States military?\u003Cbr>□ Yes □ No |  |  | Are you an employee of Encompass Community Services (√)?\u003Cbr>□ Yes □ No If yes, which program? ","cbCaicjr4LncNcJh","https://ap.wps.com/l/cbCaicjr4LncNcJh","pdf",627349,"English","# How did you hear about our program?\n# Pregnant Woman’s Information\n## Contact and household details\n## Military and employment questions\n## Preferred language for written materials\n# Spouse/Partner’s Information\n# Family Size\n## Household members and support\n# Pregnancy Verification\n# Family Circumstances\n## Events in the last 2 years\n# Income Eligibility Questions","[{\"question\":\"What eligibility requirements must be met for the Pregnant Woman program?\",\"answer\":\"Eligibility is based on meeting current year Federal Poverty Guidelines through income or qualifying for categorical (automatic) eligibility. Categorical eligibility includes receiving CalWORKs benefits, having a supported household member receiving SSI, or meeting the McKinney-Vento homelessness definition.\"},{\"question\":\"What documents are required to determine eligibility?\",\"answer\":\"Submit the completed application with copies of income documents and pregnancy verification, including a letter from a doctor and/or an ultrasound printout. Processing will not occur without these documents.\"},{\"question\":\"How can the application be submitted, and how is information handled?\",\"answer\":\"The application can be submitted in person or mailed to the listed address. All information is kept confidential and is used to determine eligibility and prioritize placement on the wait list.\"}]","PREGNANT WOMAN’S APPLICATION - Confidential | PDF",1789498657]