Please fill out all fields, including gross income before taxes for the year. If one of your children has attended Head Start in the past or you receive a duplicate message, please call us at 616-453-4145 and we can complete the application with you over the phone. This means that you are already in our computer system, so we will need to complete it with you over the phone.
Parent/Guardian
The Primary Adult is the Parent/Guardian who lives in the home.
First Name (Required)
Last Name (Required)
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
White
Hispanic
Yes
No
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Address
Head Start defines "experiencing homelessness" as living in a shelter, motel, hotel, campground, vehicle, or in a residence that is not fixed, regular or adequate.
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.
Additional Parent/Guardian
Please include only if second parent/guardian lives in the home.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
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
White
Hispanic
Yes
No
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Family Information
Please answer all questions in this section, and remember to list your total gross income for the year. Income can include any or all of the following: wages from a job, unemployment, Social Security, cash assistance (TANF), child support, or veteran's benefits. If you have no income at all, please put 0.
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
Albanian
American Sign Language
Amharic
Arabic
Armenian
Bambara (Mande)
Bengali
Bisaya
Bosnian
Burmese
Caribbean Languages
Chaldean
Cichewa
Creole
Dari
Dinka
East Asian Languages
English
European & Slavic Languages
Falam
Farsi
French
German
Hakha
Hausa
Hindi
Italian
Karen
Kibembe
Kinyarwanda
Kirundi
Kiswahili
Lingala
Mam
Mandarin
Mandingo
Matu
Middle Eastern & South Asian Languages
Mixteco
Native Central American, South American, and Mexican Languages
Native North American/Alaska Native Languages
Nepali
Oromo
Other
Pacific Island Languages
Pashto
Persian
Portuguese
Russian
Saho
Somali
Spanish
Swahili
Tagalog
Tamil
Tedim
Tigre
Tigrinya
Turkish
Vietnamese
Is another language being acquired or learned at home?
Yes
No
Number in Household
Number in Family
Gross Annual Income
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 list the child that you are enrolling into Head Start. If you need a translator, please use the "Is there anything else you want to tell us about your child and/or family" question to indicate the language needed.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
White
Hispanic
Yes
No
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/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)
Head Start Preschool 24-25
Preschool for children ages 3-5
Early Head Start 24-25
Options for pregnant persons and children 0-3
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
I certify that this information is true. I understand that the information in this application will be held in strict confidence with the agency with the exception of other preschool programs for the purpose of coordination of services, and is accessible to me during normal business hours. Head Start for Kent County will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, marital status, handicap or political beliefs. Thank you for completing the application for Head Start. A Head Start staff member will contact you by email with follow-up questions. Please respond to your email and the follow-up questions to continue processing your application.
Required information is missing, see above.