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Thank you for your interest in Triumph, Inc. Head Start and Early Head Start. This form is be used for new families only and is to collect preliminary information on your child and family so that we may contact you. Filling out this application does not guarantee a spot in one of our programs. If you are already on Triumph's waitlist or have a child in our program, PLEASE do not fill out this form. It will create a duplicate record.

Parent/Guardian information (Adult)

First Name (Required)

Last Name (Required)

Birthday (Required)

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.

Child's Relationship

Custody

Please provide us the address of where the parent/guardian and the child live.

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.

Are there other adults in the household?

Add Another Adult

Please tell us about the child you wish to enroll.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

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?

How did you hear about us

Prefer Verbal Communicati (Required)

Prefer Written Communicat (Required)

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

Please hit "submit" to finalize your application. A member of our enrollment team will contact you as soon as possible. Thank you.

Required information is missing, see above.

Parent/Guardian

Address

Other Adults

Child (Applicant)

Location Preferences

Additional Applicant

Siblings