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To qualify, you must be a resident of Leon, Jefferson and Franklin. APPLICATIONS WILL NOT BE PROCESSED FOR ENROLLMENT UNTIL ALL DOCUMENTATION ARE PROVIDED AND VERIFIED. Children must be 3 to 4 old by September 1 of the year which you are applying

Child must be 3 or 4 years old by September 1of the year for which you are applying.

Child's Birth Certificate or Passport

Proof of Guardianship (if your name is not on the Child's Birth Certificate)

Valid driver licenses, Student I.D., State Issue I.D.

Verification of all family income of (Parent(s) or Guardian(s) for the past 12 months such as:

Most Current Income Tax form (1040, 1040A, W-2, 1099, etc.)

Check Stubs (last four (4) check stubs)

SSI, SSA, or Social Security Benefits (current award letter(s))

Proof of residency (current lease and current utility bill)

Child Support -total distribution (12 consecutive months)

Unemployment Compensation - current unemployment Letter of Eligibility

TANF (Cash Assistance) - computer printout from the Department of Children & Families

Statement from Employer - on letterhead that includes date of hire, current pay rate, number of work hours per week, total income for the last 12 months, verification signature & date.

Military Pay Stubs, Veteran's Pay Stub

Foster Grandparents Court Order Papers

Parent/Guardian

Please answer questions about education, employment and income based on the date of the application. For teen parents, only enter 'Yes' if 19 years or younger on the date of application.

First Name (Required)

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?

Address

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

Additional Parent/Guardian

Only complete this section if the Secondary Adult is currently living in the home, being supported by the same income and related by blood, marriage or adoption.

Is there another parent/guardian in the family?

First Name (Required)

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

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

Family Information

For TANF, SSI, WIC or SNAP only answer 'Yes' if you are currently receiving those benefits. Proof of Income and copies of awards letters will be requested.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

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?

Emergency Contacts

Add Emergency Contact

Child (Applicant)

The child must be 3 years old, or must turn 3 by September 1. Proof of age is required.

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?

Is there anything else you want to tell us about your child?

Location Preferences

Which program are you applying for? (Required)

Head Start Program 2024-2025

No Cost Preschool for Children Ages 3 to 5

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 application

Required information is missing, see above.