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
American Sign Language
Amharic
Arabic
Awngi
Bengali
Berber
Burmese
Chinese
Croatian
English
Fijian
French
Fulani
German
Gujarati
Haitian-Creole
Hindi
Italian
Japanese
Korean
Kurdish
Kwale
Lao
Mandingo
Mixteco
Nepali
Palauan
Patois
Portuguese
Quichean
Russian
Somali
Spanish
Swahili
Thai
Tigrinya
Turkish
Twi
Urdu
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
American Sign Language
Amharic
Arabic
Awngi
Bengali
Berber
Burmese
Chinese
Croatian
English
Fijian
French
Fulani
German
Gujarati
Haitian-Creole
Hindi
Italian
Japanese
Korean
Kurdish
Kwale
Lao
Mandingo
Mixteco
Nepali
Palauan
Patois
Portuguese
Quichean
Russian
Somali
Spanish
Swahili
Thai
Tigrinya
Turkish
Twi
Urdu
Vietnamese
Wolof
Yiddish
Yoruba
Zomi
Other Language Proficiency
Little
Moderate
None
Proficient
Location Preferences
Which program are you applying for? (Required)
Head Start 2021-2022
Ages 3 to 5 years
Early Head Start 2021-2022
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. 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.