Welcome to the CDCFC Head Start! After completing this online intake form, you will be contacted to complete the application.
Parent/Guardian
Enter information about the child's primary guardian.
First Name (Required)
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
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.
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Language (Swahili, Wolof, Somali)
American Sign Language
Caribbean (Haitian-Creole, Patois)
East Asian (Chinese, Korean, Vietnamese, Lao, Thai)
English
European & Slavic (German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
Middle Eastern & South Asian (Arabic, Hindi, Urdu, Bengali, Turkish, Kurdish)
Native Central American, South American and Mexican (Mixteco, Quichean)
Native North American/Alaska Native
Pacific Island (Palauan, Fijian)
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Enter your permanent or temporary living 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.
Child (Applicant)
Enter information pertaining to the child you are enrolling.
First Name (Required)
Last Name (Required)
Birthday (Required)
English Proficiency
Little
Moderate
None
Proficient
Other Language
African Language (Swahili, Wolof, Somali)
American Sign Language
Caribbean (Haitian-Creole, Patois)
East Asian (Chinese, Korean, Vietnamese, Lao, Thai)
English
European & Slavic (German, French, Italian, Croatian, Yiddish, Portuguese, Russian)
Middle Eastern & South Asian (Arabic, Hindi, Urdu, Bengali, Turkish, Kurdish)
Native Central American, South American and Mexican (Mixteco, Quichean)
Native North American/Alaska Native
Pacific Island (Palauan, Fijian)
Spanish
Other Language Proficiency
Little
Moderate
None
Proficient
Location Preferences
Which program are you applying for? (Required)
Early Head Start 2020-2021
Ages 6 weeks to 3 years
Head Start 2020-2021
Ages 3 to 5 years
1st Location Preference
<p></p>
2nd Location Preference
<p></p>
- 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
Documents required for the application: 1. Income Verification: Tax return 1040, W2, pay stubs, or letter from employer on letterhead 2. Public Assistance Documentation (Only cash assistance or SSI-Supplemental Security Information) 3. Birth Verification (Birth certificate) Additional information needed: 4. Immunization Records (With child's name) 5. Health Insurance Information (Insurance card)
Required information is missing, see above.