Apply Online

You can now start your application process online! You will be contacted after you submit the online application to complete your application packet with a Family Advocate. You must have a valid email address to submit an online application for Johnston Lee Harnett Early Head Start/Head Start programs. If you do not have an email address at this time, or if you have previously submitted an application for a previous school year, you can print an application, complete all questions and submit to our administrative office at 1102 Massey Street, Smithfield, NC, (919) 934-2145 or any of our center locations.

Please complete the following information for the Primary Adult/Guardian

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

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

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

To determine if families are experiencing homelessness, Johnston Lee Harnett EHS/HS utilizes the McKinney-Vento Homeless Assistance Act's legal definition of homelessness. Families without a fixed, regular, and adequate nighttime residence; families sharing the housing of others due to loss of housing, financial difficulties, or a similar reason; families living in motels, hotels, trailer parks, or camping grounds due to a lack of alternative accommodations; families living in emergency or transitional shelters; individuals abandoned in hospitals or awaiting foster care placement

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

Please fill out the following information ONLY if the secondary Parent/Guardian lives in the same household as the child you are applying for.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address

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

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

Please complete the form below to tell us about your family. Parental Status should indicate the parent(s)/guardian(s) who live with the child for whom you are applying.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

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?

Add Emergency Contact

Please fill out the form below for the child you want to be considered for enrollment.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

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 the Early Head Start/Head Start program at Johnston Lee Harnett. You certify that the information you have provided is complete and accurate by clicking the button below. We will contact you to schedule an appointment to complete the application process.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings