Thank you for your interest in our program! This form is the first step in our enrollment process. Rutland County Head Start provides free, high-quality early childhood care and education for children ages 0-5 and holistic support for your family. We haves two centers located in Rutland City and operate from 8am-2pm. If you need assistance completing this form or have additional questions, please call 802-775-8225.
Parent/Guardian
First Name (Required)
Middle Name
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.
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
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Primary Language at Home
American Sign Language
Arabic
English
French
Spanish
Is another language being acquired or learned at home?
Yes
No
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Child (Applicant)
In the notes section, please include if your child has any health needs, including asthma/use of inhaler, allergies, or dietary needs. *This information will not impact enrollment.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Doctor/Medical Home
*Do Not Have
*Other
Adirondack Pediatrics
Castleton Community Health
CHCRR
CHCRR- Pediatrics
DHMC Ped'S
Dr. Wood
Essex Pediatrics
Forensic Consultations
Gifford Medical Center
Mousetrap Pediatrics
Reach Health Care
RRMC Rutland Regional Medical
Southwestern Vermont Medical
UVM Medical Center
WIC
Dentist/Dental Home
*Do Not Have
*Other
Community Dental
Community Kids Dental
Cornerstone Dentistry
Elite Dental
Middlebury Ped-Dentistry
Pediatric Dental Group
Rutland Dental Care
Timberlane
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 (Infant/Toddlers)
Infant/Toddlers ages 6 weeks-3 years old
Head Start Preschool
Preschool for Children Ages 3 to 5
Location Preference
<p></p>
1st Location Preference
<p></p>
2nd Location Preference
<p></p>
3rd 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
Required information is missing, see above.