Please fill in the application form completely and accurately. If you have ever filled out an application in the past, please stop and call 541-323-6543. The information you provide will help us determine your child’s eligibility for Head Start / Early Head Start and help us prioritize your application. This application is part of an intake process and does not guarantee enrollment into the program. All shared information will be held in strict confidence. If you are uncomfortable completing any part of this application, have questions about your eligibility, or would like to discuss your situation with a staff member, please contact Dawn Adams, Family and Community Partnership Coordinator at 541-323-6543. To qualify for services your child must be 3 or 4 years old on or before September 1st of the year you are applying. Intentionally falsifying information to gain program enrollment may result in your child not being allowed to participate in Head Start or Early Head Start programs.
Please provide as much information as possible if you have any questions or concerns please call 541-323-6543
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Includes adults who are related by blood, marriage, or adoption and are living within the same household as the child applicant.
Head Start must know how many people are living in your household and the total family income in order to determine if your family income is at or below the Federal poverty guidelines. Family is defined for our purposes as “all persons living in the same household who are supported by the income of the parent(s) or guardian(s) of the enrolling child and are related to the parent(s) or guardian(s) by blood, marriage, or adoption.”
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Thank you for your interest in NeighborImpact Head Start / Early Head Start. If you have questions or have not received a response to your application within seven days, please call 541-323-6543.
Required information is missing, see above.