Complete the information and submit. All information will be kept confidential. We offer services to children ages birth to five and pregnant women. Any family may apply for Head Start, but priority is given to eligible families and children with special needs (disabilities). We serve the following counties: Rock, Nobles, Pipestone, and Murray.
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)
Middle Name
Last Name (Required)
Birthday (Required)
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
Yes
No
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
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Native
American Sign Language
Amharic
Anuak
Arabic
Creole
Dinka
East Asian
English
German
Ixil
Karen
Kiché
Laotian
Mam
Oromo
Other
Sign Language
Spanish
Sudanese-Anwak
Swahili
Thai
Tigrinya
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 1 (1st Grade)
Grade 10
Grade 11
Grade 12
Grade 2 (2nd Grade)
Grade 3 (3rd Grade)
Grade 4 (4th Grade)
Grade 5 (5th Grade)
Grade 6 (6th Grade)
Grade 7 (7th Grade)
Grade 8 (8th Grade)
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
Is your family experiencing homelessness?
Yes
No
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
Fill out this section only if the Secondary Adult is the child's other parent, authorized caregiver, or legally responsible party. In addition, it could be another adult living at home with the child, being supported by the child's parents or guardians, and being related by blood, marriage, or adoption to the child's parent(s).
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Mobile Phone
Opt In for Text Messages
Yes
No
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
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African
American Native
American Sign Language
Amharic
Anuak
Arabic
Creole
Dinka
East Asian
English
German
Ixil
Karen
Kiché
Laotian
Mam
Oromo
Other
Sign Language
Spanish
Sudanese-Anwak
Swahili
Thai
Tigrinya
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 1 (1st Grade)
Grade 10
Grade 11
Grade 12
Grade 2 (2nd Grade)
Grade 3 (3rd Grade)
Grade 4 (4th Grade)
Grade 5 (5th Grade)
Grade 6 (6th Grade)
Grade 7 (7th Grade)
Grade 8 (8th Grade)
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
African
American Native
American Sign Language
Amharic
Anuak
Arabic
Creole
Dinka
East Asian
English
German
Ixil
Karen
Kiché
Laotian
Mam
Oromo
Other
Sign Language
Spanish
Sudanese-Anwak
Swahili
Thai
Tigrinya
Vietnamese
Is another language being acquired or learned at home?
Yes
No
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
WIC ID (if applicable)
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Nickname
Birthday (Required)
Gender
Female
Male
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Early Head Start 2024-2025
Head Start 2024-2025
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd Location Preference
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- 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 the SMOC Head Start program. Please click Submit to finalize your interest information. We will contact you to set up an intake appointment within 14 days upon receiving your application. Plan for a 30-minute appointment. Please bring with you to the appointment the following documents: Proof of all income from the last 12 months (1040 tax form, W-2s, child support statements, SSI, Social Security benefits, unemployment compensation, workers compensation, scholarships, grants, foster care placement), Child's birth certificate, Insurance card (if applicable). If possible, please bring the following also: Immunization record, Physical Exam, and Dental Exam.
Required information is missing, see above.