Welcome to Washtenaw County's Preschool Pre-Application for Head Start and Great Start Readiness Program!

Let's get started!

This pre-application helps us learn more about your child and family so we can connect you with preschool programs that best meet your family's needs.

Please complete each section as accurately and completely as possible. Your child may be considered for more than one preschool program or location based on eligibility, family preferences, and program availability.

Need help with the application?
For step-by-step information, preschool locations, and additional resources, click here .

Primary Adult

Who should be listed as the Primary Adult?
The Primary Adult should be the parent, guardian, or primary caregiver who lives with the child.

Please enter the information for this adult below.

If another parent, guardian, or caregiver is part of the child's household, you will have an opportunity to enter their information in the Secondary Adult or Other Adults sections.

Please enter information as completely and accurately as possible. Some of the information collected in this section helps determine program eligibility and services available to your family.

First Name (Required)

Last Name (Required)

Suffix

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

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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Estimated Income

Your Living Address

Important: Do not enter your full address on both lines.
Line 2 should only be used for an apartment, lot, or unit number.

Line 1 – Street Address
Enter your house number and street name.

Example: 123 Main St.

Line 2 – Apartment, Lot, or Unit Number
Enter only your apartment, lot, or unit number.

Example: Apt 101

Leave Line 2 blank if you do not have an apartment, lot, or unit number.

Do not repeat your street address in Line 2.

Housing Information:
A family may be considered to be experiencing homelessness if they are living in a shelter, motel or hotel, campground, vehicle, or another living situation that is not fixed, regular, and adequate.

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.

Secondary Adult

Who should be listed as the Secondary Adult?
Complete this section only if there is a second parent, guardian, or caregiver who lives in the child's household.

This may include a second parent, stepparent, guardian, grandparent, or another adult who shares responsibility for the child and lives in the home.

Does the child's other parent live somewhere else?
Do not enter them as the Secondary Adult just because they are the child's parent. This section is for an adult who lives in the child's household.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Suffix

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

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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Family & Household Information

Please answer all questions in this section.
This information helps us understand your family and determine eligibility for programs and services.

Please provide information about your household, family size, languages spoken at home, and any public benefits or services your family currently receives.

Household and Family Size
Please answer these questions based on your family's current living situation. If you are temporarily staying with another person or family, do not automatically include everyone living at that address as part of your family.

Emergency Contact
Please provide information for someone we can contact if we are unable to reach you.

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?

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

Child Information

Tell us about the child who is applying for one of our programs.
Please enter the child's information as completely and accurately as possible.

You will be asked about your child's language, health coverage, medical and dental care, and any disability or special needs.

Health & Development Information
Please answer these questions based on your child's current information. If your child does not currently have health or dental coverage, a doctor, or a dentist, you may indicate that in the questions below.

Is there anything else you would like us to know?
Use the Application Notes question to share information that may help us better understand your child or family's needs.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Lives with Family (Required)

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Medicaid Eligibility

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

Certification

I certify that the information provided in this pre-application is true and accurate to the best of my knowledge. I understand that the information in this pre-application will be kept confidential, except when shared with other preschool programs for the purpose of coordinating services. I understand that this information is available to me during normal business hours.

Thank you for completing your preschool pre-application!

A program staff member will contact you regarding the next steps in the application process.

Please remember: Submitting a pre-application does not guarantee enrollment or placement at a specific program or location.

Required information is missing, see above.

Welcome to Washtenaw County's Preschool Pre-Application for Head Start and Great Start Readiness Program!

Parent/Guardian

Primary Adult

Address

Your Living Address

Additional Parent/Guardian

Secondary Adult

Family Information

Family & Household Information

Emergency Contacts

Child (Applicant)

Child Information

Location Preferences

Additional Applicant

Siblings