Apply Online

Dear Parent(s): Thank you for your interest in enroll your child in Rockingham County School Head Start. Children who meet the following requirements may enroll in the RCS Head Start program: •Child must reside in Rockingham County •Child must be 3 years of age by August 31st Your child application MUST include the following documents attach to be processed: •Birth Certificate •Shot/Immunization Records (Current) •Medicaid/Other Insurance card •Physical (Current) •Income verification for all parents in the household (2023 W2's Forms, 2023) Tax Returns, Child Support, Work First,, Disability, SSI, Financial Aid, etc). •Custody Papers, Divorce Documentation, or any other legal documents relating to the child (if applicable). •SNAP (Approval Letter Preferable or card for verification) •Proof of Address (Bill with current name and address) RCS Head Start is based on a point system. Income is only one portion of the point system. The child's age and family factors will also contribute to the child's total points. If you have any questions please do not hesitate to call us at (336) 548-4780. Thank you, Family Service Department "Ensure school readiness and self-sufficiency for at-risk children and families in Rockingham County”

Primary adult (Mother/Step-Mother/Father/Step-Father/Guardian/Grandparent)

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

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

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status (Required)

Child's Relationship (Required)

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

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

Only complete this section if the secondary adult is currently living in the home, being supported by the same income and/or related blood marriage, adoption or by temporary placement (Mother/Step-Mother/Father/Step-Father/Guardian/Grandparent).

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

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

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status (Required)

Child's Relationship (Required)

Custody

Lives with Family

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

Are there other adults in the household?

Add Another Adult

Information about the family.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income

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?

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?

Add Emergency Contact

Child that is applying for Head Start. If your child has an IEP or IFSP in place, please place diagnosis along with the services begin and end dates in the note section below.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

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?

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

Please click submit to finalize your application. We will contact you to set up an intake appointment.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings