Apply Online

Thank you for beginning your application to Head Start for the 2024-25 school year. Please complete the following information to begin the process and help us determine eligibility. Please remember you will also need to submit the following documents before we can determine your child's eligibility for Head Start:
*Income Verification (examples--2023 tax forms, W-2s, child support, 3 recent pay stubs, letter of employment, TANF, SNAP, and SSI),
*Child's Birth Certificate,
*Child's Social Security Card, and
*Parent/Guardian Photo ID.
These documents may be attached at the end of the online application, delivered to one of our Head Start sites, or emailed to: cbogue@kokomo.k12.in.us.
Once we have received your application, we will contact you to set up an intake appointment. Please remember submitting all your documents early helps speed up the process.
Additional documents will be needed after eligibility is determined, but before a spot can be secure. These documents are listed at the end of the application.
Please fill in all applicable fields when completing the online application.

Please complete this information about the child's primary parent or guardian. If the primary adult is not listed on the birth certificate, please be prepared to provide documentation showing guardianship.

First Name (Required)

Middle Name

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 (Required)

Opt In for Text Messages

Home Phone (Required)

Work Phone (Required)

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

If Teen Parent, Subsidized?

Please complete the following information about the child's primary place of residence. Please note that "homelessness" is defined as "lacking a fixed, regular, and adequate nighttime residence." This may include sharing housing, living in motels/hotels, living in shelters, or living somewhere not designed to be housing.

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

Complete this section for the child's secondary parent or guardian.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Mobile Phone (Required)

Opt In for Text Messages

Home Phone (Required)

Work Phone (Required)

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

If Teen Parent, Subsidized?

Are there other adults in the household?

Add Another Adult

Please complete for the family unit the child resides with. You will also need to designate Contacts. Contacts should be adults that we can contact if we are unable to reach the primary and/or secondary parent/guardians. For each contact you will designate if they are an emergency contact and/or if your child may be released to them. Children may only be released from school or the bus to people listed on the contact list. Each child must have at least one contact, but ideally has a minimum of three. You will click the "Add Emergency Contact" button for each person.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Household

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?

WIC ID (if applicable)

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?

Add Emergency Contact

Please complete this section for child planning to attend Head Start.

First Name (Required)

Middle Name (Required)

Last Name (Required)

Nickname

Birthday (Required)

Gender (Required)

SSN

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Other Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

Dentist/Dental Home

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 your interest in Head Start! Please read below and then hit submit when you are finished.

By submitting this document you are certifying that this information is true. If any part is false, your participation in the Head Start program may be terminated and you may be subject to legal action. All information in the application will be held in strict confidence within the agency and is accessible during normal business hours.

Remember, we will need copies of all proof of income, child's birth certificate, child's social security card, and parent/guardian id to determine your eligibility. Copies may be attached on the next screen, delivered to one of our Head Start sites, or emailed to cbogue@kokomo.k12.in.us.
Please be sure to include parent and child's name on any documents you email or drop off.
If you have any questions, please call our office at 765-454-7082 from 8am-4pm, Monday thru Friday.
Thank you and we look forward to working with your family.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings