Hello and welcome to the Head Start Online Application! Your application is considered incomplete until we receive proof of income, guardian information, and immunization records. Thank you.
Parent/Guardian
Please enter all of your information.
First Name (Required)
Middle Name
Last Name (Required)
Nickname
Birthday (Required)
Gender
Female
Male
Email Address (Required)
Confirm Email Address
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Languages
American Sign Language
Caribbean Languages
East Asian Languages
English
European & Slavic Languages
Middle Eastern & South Asian Languages
Native American Languages
Native Central/South American
Other
Pacific Island Languages
Spanish
Unspecified
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Bachelor Degree or Higher
GED
Grade 8 or less
Grade 9 or more - non graduate
High School Diploma
Some College / Technical Training
Employment Status
Employed
Employed and in Job Training
Unemployed
Unemployed and in Job Training
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Address
Please enter mailing address if different then living address by unclicking the check box. Thank you
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
Click here
to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Only enter a secondary adult if they are residing in the household, and related to the child by blood, marriage or adoption. Do not list parents not living in the home.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Nickname
Birthday (Required)
Gender
Female
Male
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Languages
American Sign Language
Caribbean Languages
East Asian Languages
English
European & Slavic Languages
Middle Eastern & South Asian Languages
Native American Languages
Native Central/South American
Other
Pacific Island Languages
Spanish
Unspecified
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Bachelor Degree or Higher
GED
Grade 8 or less
Grade 9 or more - non graduate
High School Diploma
Some College / Technical Training
Employment Status
Employed
Employed and in Job Training
Unemployed
Unemployed and in Job Training
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Family Information
Parental Status: If you entered a primary and secondary adult, select Two Parent family. If you entered just a primary adult select One Parent Family. For number in the household, count primary, secondary adults and all children under the age of 18 living in the home supported by the parents/guardian.
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
African Languages
American Sign Language
Caribbean Languages
East Asian Languages
English
European & Slavic Languages
Middle Eastern & South Asian Languages
Native American Languages
Native Central/South American
Other
Pacific Island Languages
Spanish
Unspecified
Number in Household
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
Please enter any developmental or other concerns below in the section asking you to share information about your child. Thank you
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Languages
American Sign Language
Caribbean Languages
East Asian Languages
English
European & Slavic Languages
Middle Eastern & South Asian Languages
Native American Languages
Native Central/South American
Other
Pacific Island Languages
Spanish
Unspecified
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Infants and Toddlers
2023-2024 HQEL
Preschool 3-5 years
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd Location Preference
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- Your Address
- Available Locations
Click a location on the map to see more info
Click here
to find a provider in your area.
Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Siblings
Are there other children in the family?
Add a Sibling
After you have submitted the application, a Head Start staff member will contact you to complete the application process. Items required to finish the application are child's immunization record, birth certificate or guardianship paperwork, proof of income. Thank you for your time!
Required information is missing, see above.