Apply Online

| Applicant must be 3-4 years of age by September 1, 2024 | Please enter a valid email address and phone number | All questions must be answered | PLEASE NOTE: This is only this first step in the Registration Process | Only complete one application per child | Please email johnsonglenda@bcsdschools.net if you have issues completing this form | Thank you for your interest in Berkeley-Dorchester Head Start |

The primary adult is the person that has primary custody of the child and whom the child lives with.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

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

Hispanic

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

Please enter your living address. You must provide 2 proof of residency for this address The following are documents that we accept: parent/legal guardian's current monthly utility bill (electric, gas, water) showing his/her correct name and address parent/legal guardian's current monthly land line phone statement showing his/her correct name and address parent/legal guardian's rental lease or real estate purchase contract showing his/her correct name and address parent/legal guardian's cable or satellite bill showing his/her correct name and address parent/legal guardian's rent receipt showing the address of the dwelling as well as the landlord/landlady's name, address and telephone number; statements from apartment complexes or other multiple dwellings need to be on letterhead stationary showing the appropriate information mentioned above address at which the individual receives local, state and/or federal financial assistance individual with whom the tax assessor's office lists as the owner of the property existence of a deed identifying the owner of the property

Is your family experiencing homelessness?

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

Only enter a secondary adult if the primary adult is married or the biological father of the child (applicant) lives in the home.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Email Address

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

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

Hispanic

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

Number in Family

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

Add Emergency Contact

Your child must be 3 or 4 years of age by September 1, 2024.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language Proficiency

Primary Health Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

Thank you for your interest in Berkeley-Dorchester Head Start 2024-2025 School year. Please check your email to receive information on your next step. Director: Antoinette Jones ERSEA Specialist: Glenda A Johnson

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings