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
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
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.
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Address
Please provide us the address of where the parent/guardian(s) and the 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.
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
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?
How did you hear about us
Community Agency -WIC, DCF, etc.
Community TV posting
Current or Past Parent
Early Intervention
Facebook
Flyer
Friend/Non-Parent
Google
Public School/Special Ed School
Triumph Staff Member
Prefer Verbal Communicati (Required)
Cape Verdean
English
Haitian Creole
Hearing Impaired Accommodation
Other
Portuguese
Spanish
Prefer Written Communicat (Required)
Cape Verdean
English
Haitian Creole
Other
Portuguese
Spanish
Location Preferences
Which program are you applying for? (Required)
Expectant Families, Infants & Toddlers
Expectant Families, Infants & Toddlers
Preschool Program
2.9 years to 5 years old
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
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.