Please complete all information requested on the Enrollment Application as thoroughly and accurately as possible in order for us to make the best determination of eligibility for services. I understand that I will be asked to verify family income and I affirm that the information I provide is valid.

If you would prefer to download our application*, please click here.

*Your computer must have a PDF Reader Program to correctly display the portable document format (.pdf) files located on this website. If your computer does not have a PDF Reader installed you can download one, for free, at the following link: Adobe Reader.
Please enter the information relating to the Primary Adult in the household. If you are applying for a pregnant woman please enter the name of the father of the unborn child.
Please enter the complete address, zip code, city, county and school district. Enter the home phone number and cell phone number or if you do not have a phone number enter a phone contact with name of contact.
Click here to find a provider in your area.
Please enter the information relating to the Secondary Adult in the household. This person must be either the biological parent or married to the parent of the child you are applying for.
Please enter the Parental Status, number living in home and gross annual income(Prior 12 months). Please check if you are receiving cash benefits under the TANF program, Social Security or Social Security Supplemental Income.
Please enter the name of the child you are applying for.
- 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
Thank you for your interest in either the Head Start Program, Early Head Start Program or Pre- K Program. Please click submit to finalize your application. I understand this information will be held confidential and is used to determine eligibility but does not guarantee enrollment into any program. Jefferson-Clarion Head Start, Inc. does not discriminate on the basis of sex, age, religion, race, national origin or disabilities.
Required information is missing, see above.