Welcome to Mississippi Action for Progress, Inc.

Application for Head Start Services

Please fill out the application to the best of your knowledge and in its entirety. All items with Required are to be completed in order to properly process your application.

First Name (Required)

Middle Name

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

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 list the current living address for your family. Fill in all required fields.

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

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

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.

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Number in Household

Number in Family

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

Fill in all required fields.
Hours of Operation- 7:30 am - 5:00 pm

Days of Operation: M - F

Meals Served- Breakfasts, Lunch & Snack

Your child must be age eligible on or before September 1. For example, If Johnny's 3rd birthday is August 30, 31 and/or September 1 then he is eligible for Regular Head Start. Any date after September 1, he will be ineligible for the program.

Please only select 1 Location Preference below this section. This will increase the processing of your application.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Primary Health Coverage

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?

Location Preferences

Which program are you applying for? (Required)

Head Start 2024-2025

Head Start 2023-2024

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.

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 our Head Start Program. Please click "Submit Application" to finalize your application. We will contact you to setup an intake appointment.

Required information is missing, see above.

Welcome to Mississippi Action for Progress, Inc.

Application for Head Start Services

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings