enrollment application

We are now accepting enrollment applications for the 2017-2018 program year.

A link to download the enrollment application is provided below. You may also obtain an application at your nearest Center, or at our Central Office.



1.   A form of legal documentation to prove the child’s age, such as birth certificate, hospital record or Medicaid/ARKids card.

2.   Household income verification for the past twelve months.  (Check stubs, tax returns, W-2s, employer statements, TEA, Social Security, SSI, Child Support, Unemployment, Veterans Benefits, etc.)  Household income includes all means of support for the last twelve months from all parents/guardians of the child who also live in the same household as the child. 

If the child has a diagnosed disability, documentation relating to the disability must be provided along with this application.

If your child is accepted for enrollment in one of our programs, then you will be asked to supply copies of the following documentation (you may also provide these documents now in order to expedite the enrollment process):

1.   State birth certificate or hospital record.  (Applications for Arkansas state birth certificates are available from F.A.C.T., Inc. upon request.)  

2.   Immunization Record - Shots must be current according to the age of the child.  Check with your physician or local health clinic.       

3.   Medicaid Card/ARKids or Private Insurance (if applicable).  (Medicaid/ARKids applications are available upon request.)

Should you have any questions regarding the required information, please contact the ERSEA Coordinator at (870) 862-4545 or your local center.


Application Steps

  • Acquire Application

    Download and print the "Enrollment Application" by clicking the link to the left or pick an application up in person at any of our locations.

  • Complete & Return

    Complete and return the application to us in person, fax, or e-mail (see map).

  • Bring Documents

    Send or bring required eligibility documents to your nearest location, fax, or e-mail. 

  • Eligibility Determined

    A F.A.C.T., Inc. representative will determine your eligibility for programs based on your application and supporting documentation. 

  • Staff Contact

    A F.A.C.T., Inc. representative will contact you if an enrollment opportunity becomes available. Slots are filled based on greatest need. Applications are active for one school year.