Hearts of Texas Head Start and Early Head Start
A program of Cen-Tex Family Services, Inc.
Serving Bastrop, Lee, Fayette, and Colorado Counties


Once your application is submitted, we will be contacting you to set up an information verification appointment within 7 (seven) business days. Please bring the following to this appointment:
* Copy of your child's birth certificate or birth facts record (driver's license or other government photo ID for pregnant mothers)
* Income verification for the past 12 months or the preceding calendar year. Income verification forms include: W-2 forms, pay stubs, Tax Return, SSI statement, TANF statement, or other authorized documentation - This includes Child Support documentation
* If your child has a disability and/or disorder, a copy of the latest documentation to support the diagnosis (IEP, IFSP, physician statement of diagnosis, etc.)
* Referrals from Community Agencies (ECI, DSHS, etc.), if applicable
* Foster and/or Kinship Placement Authorization documentation, if applicable

Failure to bring in the above documentation to the verification meeting can delay application processing and may result in your child not being considered for enrollment

DO NOT USE ALL CAPITAL / UPPERCASE LETTERS when completing the application as this can result in a delay in processing

You MUST include ALL members of the immediate family living within the family unit (mother, father, siblings) on the application. Failure to do so will result in a delay in processing your application

Parent/Guardian

Use the legal name of the individual. The legal name is the same as what is on a government issued photo-ID.

Failure to include Race and Employment Status can result in a delay in processing

Address

This is your RESIDENTIAL or HOME Address. Use Address Line 2 for any Apartment, Unit, or Lot numbers.
Only one part of the address per line. Failure to fill out the address properly will result in you not receiving important enrollment information

If you receive your mail at another address, such as a PO box, uncheck the box under Residential address and enter that information in the Mailing Address form that will appear. Do NOT include a PO BOX in the second line of the Residential address as mail WILL NOT BE DELIVERED by the post office.
Click here to find a provider in your area.

Additional Parent/Guardian

This includes the mother, father, step-parent, of the child(ren) you are applying for. If they are in the home, they MUST be included on this application to avoid penalties for falsification of information.

Use the legal name of the individual. The legal name is the same as what is on a government issued photo-ID

Failure to include Race and Employment Status can result in a delay in processing

Other Adults

Are there other adults in the household?

Add Another Adult

Family Information

The following information is required to determine a child's eligibility. If you select ANY of the items below, you must bring support documentation to the in-person interview.

Child (Applicant)

Use the legal name of the individual. The legal name is the same as what is on the birth certificate or birth facts form. This includes any hyphens (-).

If your child has a diagnosed disability or is currently in treatment/therapy, please bring supporting documentation from the doctor or therapist (IEP, IFSP, etc.) with you to the in-person interview.

Location Preferences
- 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
Thank you for your interest in Hearts of Texas Head Start. By clicking the Submit Application button below to finalize your application, you are agreeing to the following statement

I certify that the information on this application is true and correct. I understand that this application DOES NOT AUTOMATICALLY "ENROLL" MY CHILD OR MYSELF IN THE HEAD START/EARLY HEAD START PROGRAM. If my child or I are selected for enrollment and it is discovered that I gave false information during the application process, my child or myself can be removed from the program

In accordance with Federal civil rights law and U.S. Department of Agriculture (USDA) civil rights regulations and policies, the USDA, its Agencies, offices, and employees, and institutions participating in or administering USDA programs are prohibited from discriminating based on race, color, national origin, sex, disability, age, or reprisal or retaliation for prior civil rights activity in any program or activity conducted or funded by USDA. Persons with disabilities who require alternative means of communication for program information (e.g. Braille, large print, audiotape, American Sign Language, etc.), should contact the Agency (State or local) where they applied for benefits. Individuals who are deaf, hard of hearing or have speech disabilities may contact USDA through the Federal Relay Service at (800) 877-8339. Additionally, program information may be made available in languages other than English. To file a program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, (AD-3027) found online at: http://www.ascr.usda.gov/complaint_filing_cust.html, and at any USDA office, or write a letter addressed to USDA and provide in the letter all of the information requested in the form. To request a copy of the complaint form, call (866) 632-9992. Submit your completed form or letter to USDA by: (1) mail: U.S. Department of Agriculture Office of the Assistant Secretary for Civil Rights 1400 Independence Avenue, SW Washington, D.C. 20250-9410; (2) fax: (202) 690-7442; or (3) email: program.intake@usda.gov
Required information is missing, see above.