Apply Online

Welcome to the online application for Head Start (ages 3-5) and Early Head Start (ages 0-3). We are so glad you're here! Please fill out the form to the best of your ability. Before you begin the application, you will need to know your family's gross income for the past 12 months. You may use your income tax form 1040 or W2's from the last tax year, paycheck stubs, or direct deposit statements to determine this amount. If you qualify for SNAP benefits, you can provide a copy of your SNAP benefit letter. Once the application has been submitted, a CAPNEMO Head Start representative will be in touch with you to complete the process.

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

Teen Parent

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

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

Teen Parent

Are there other adults in the household?

Add Another Adult

In this section, please list the number of people in the child's family that live in the household. NOTE: this includes ONLY adults and siblings that are related to the child applying for Head Start by blood, marriage, or adoption. Also in this section, please state your family's gross income for the past 12 months. You may use your income tax form 1040 or W2's from the last tax year, paycheck stubs, or direct deposit statements to determine this amount. If you qualify for SNAP benefits, you can provide a copy of your SNAP benefit letter.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Family

Gross Annual Income

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?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

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 submitting an application for CAPNEMO Head Start and/or Early Head Start. A representative will be in touch with you as soon as possible. If you have any questions, you may contact CAPNEMO central office at 660-665-9855.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings