Apply Online

Thank you for your interest in Jefferson County Head Start! To begin the application process, please fill in the information below. If you have any questions, feel free to contact our main office at 720-497-7900.

Main Parent/Guardian of child. Employment Status: If primary adult is working full time and is also enrolled in school, please select "full time & training". If primary adult is working part time and is enrolled in school, please select "part time & training".

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender (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 (Required)

Opt In for Text Messages

Home Phone (Required)

Work Phone (Required)

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Lives with Family

Provides Financial Support

Teen Parent

Referred to HS by (Required)

Refer Details (specify)

Preferred Language (Required)

Preferred Pronoun (Required)

Other Pronoun

Multi-Race Clarification

Please use physical living address. Lakewood residents must apply with Lakewood Head Start. Jefferson County Head Start services all of Jefferson County except for the city of Lakewood. Homeless means: lacking a fixed, regular and adequate nighttime residence. Examples include being doubled up due to economic hardship, living in a hotel, motel, car, or unsheltered.

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 who lives in same household as child. Employment Status: If secondary adult is working full time and is also enrolled in school, please select "full time & training". If secondary adult is working part time and is enrolled in school, please select "part time & training".

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender (Required)

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Referred to HS by (Required)

Refer Details (specify)

Preferred Language (Required)

Preferred Pronoun (Required)

Other Pronoun

Multi-Race Clarification

Are there other adults in the household?

Add Another Adult

Please fill out the following family information:

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned 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?

Please fill out the following information for the child you are applying for. If you are applying for more the one child there is an additional section below to add another applicant.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

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?

Referred to HS by (Required)

Refer Details (specify)

Preferred Language (Required)

Preferred Pronoun (Required)

Other Pronoun

Multi-Race Clarification

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 Jefferson County Head Start! Please click submit to finalize your application. Our staff will contact you to schedule an appointment to determine eligibility. We look forward to meeting you soon!

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings