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HEAD START / EARLY HEAD START Eligibility is based on your family income, your child’s age, and available openings. COMPLETING THIS APPLICATION DOES NOT MEAN YOUR CHILD IS AUTOMATICALLY ENROLLED IN THE HEAD START OR EARLY HEAD START PROGRAM. In addition to submitting this application you must send or attach proof of all income for 12 months (such as a 1040 tax form, child support printout, etc.) and a copy of child’s birth certificate and/or proof of pregnancy with expected due date if applicable.

Please answer all questions as completely as possible.

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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

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.

English Proficiency

Other Language

Employment Status

Child's Relationship

Custody

Teen Parent

Brightpoint Head Start and Early Head Start serves families living in Allen, Noble, and Whitley County.

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

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Email Address

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

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.

Employment Status

Child's Relationship

Custody

Teen Parent

Are there other adults in the household?

Add Another Adult

Gross annual income will need to be verified by documentation sent to the program. Please send that information to the site you selected as your preference.

Relationship to Participant(s)

Primary Language at Home

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?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

Primary Health Coverage

Insurance Number

Medicaid Number

Doctor/Medical Home

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

Thank you for your interest in Head Start and/or Early Head Start. You will receive an email from us soon with instructions regarding how to complete your application.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings