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
Please list the name of the primary caregiver of the child/children you are applying for.
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
Home Phone
Work Phone
Ext.
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
Arabic
Bengali
Cape Verdean
Caribbean Languages
Eastern Asian
English
French
German
Haitian Creole (french)
Hebrew
Hindi
Italian
Middle Eastern & South Asian
Native North American or Alaskan
Other
Pacific Island
Pauluin
Portuguese
Quichan
Russian
Spanish
Unspecified
Urdu
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Address
Please provide us the address of where the primary adult and child live.
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
Child (Applicant)
Please tell us about the child you wish to enroll.
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
Arabic
Bengali
Cape Verdean
Caribbean Languages
Eastern Asian
English
French
German
Haitian Creole (french)
Hebrew
Hindi
Italian
Middle Eastern & South Asian
Native North American or Alaskan
Other
Pacific Island
Pauluin
Portuguese
Quichan
Russian
Spanish
Unspecified
Urdu
Location Preferences
Which program are you applying for? (Required)
2019-2020 HS
Infant/Toddler Program Early Head Start
Home Based and Center Based options available
1st Location Preference
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2nd 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
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.