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)
Gender
Female
Male
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
Albanian
American Sign Language
Amharic
Arabic
Awngi
Bangwa
Bengali
Berber
Burmese
Chinese
Creole
Croatian
Dagbani
Dari
English
Fijian
French
Fulani
German
Gujarati
Haitian-Creole
Hindi
Igbo
Ijaw
Indonesian
Isoko
Italian
Japanese
Korean
Kurdish
Kwale
Lao
Malay
Mandingo
Medumba
Mixteco
Mmuock
Nepali
Oromo
Palauan
Pashto
Patois
Polish
Portuguese
Quichean
Russian
Sarakule
Serbian
Somali
Soninke
Spanish
Swahili
Telugu
Thai
Tigrinya
Turkish
Twi
Urdu
Uzbek
Vai
Vietnamese
Wolof
Yiddish
Yoruba
Zomi
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)
Gender
Female
Male
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
Albanian
American Sign Language
Amharic
Arabic
Awngi
Bangwa
Bengali
Berber
Burmese
Chinese
Creole
Croatian
Dagbani
Dari
English
Fijian
French
Fulani
German
Gujarati
Haitian-Creole
Hindi
Igbo
Ijaw
Indonesian
Isoko
Italian
Japanese
Korean
Kurdish
Kwale
Lao
Malay
Mandingo
Medumba
Mixteco
Mmuock
Nepali
Oromo
Palauan
Pashto
Patois
Polish
Portuguese
Quichean
Russian
Sarakule
Serbian
Somali
Soninke
Spanish
Swahili
Telugu
Thai
Tigrinya
Turkish
Twi
Urdu
Uzbek
Vai
Vietnamese
Wolof
Yiddish
Yoruba
Zomi
Other Language Proficiency
Little
Moderate
None
Proficient
Location Preferences
Which program are you applying for? (Required)
Head Start 2022-2023
Ages 3 to 5 years
Early Head Start 2022-2023
Ages 6 weeks to 3 years
1st Location Preference
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2nd 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
Documents required for the application: 1. Public Assistance Documentation (TANF cash assistance, SSI-Supplemental Security Information or SNAP) 2. Income Verification: If you are not on TANF cash assistance, SSI, SNAP, Foster Care, or Homeless, then income is collected. The following are acceptable types of documentation: Tax return 1040, W2, pay stubs, or letter from employer on letterhead . This is for the past calendar year or past 12 months. 3. Birth Verification (Birth certificate, etc.) Additional information needed: 4. Immunization Records (With child's name) 5. Health Insurance Information (Insurance card)
Required information is missing, see above.