Welcome to Middle Kentucky Head Start, where we provide a safe, supportive, and vibrant educational environment for children aged 3 to 5 years and their parents. Our comprehensive program addresses all areas of a child’s development: physical, mental, social, and emotional. Children and families receive a broad range of educational, nutritional, preventive health, and social services. We engage caregivers and children to address educational needs in a way that promotes long-term family sustainability. Our goal is to foster a lifelong love for learning for each of the children we serve. Please complete this form to begin the pre-screening process. Read and answer each question that is applicable to your family. All fields marked with an asterisk (*) are required.
Parent/Guardian
Please answer the questions about education, employment, and income based on the application date. For teen parents, select "Yes" only if they are 19 years old or younger on the application date.
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 (Required)
Opt In for Text Messages
Yes
No
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)
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic (Required)
Yes
No
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Address
You must provide your current living address. If the living address is different from the mailing address, provide the secondary address in the mailing address section.
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Only complete this section if the Secondary Adult is currently living in the home, being supported by the same income, and related by blood, marriage, or adoption; or are the child’s authorized caregiver or legally responsible party.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
Lives with Family
Yes
No
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Other Adults
Are there other adults in the household?
Add Another Adult
Family Information
Family includes all persons living in the same household who are supported by the child’s parent(s)’ or guardian(s)’ income; and are related to the child’s parent(s) or guardian(s) by blood, marriage, or adoption; or are the child’s authorized caregiver or legally responsible party.
Number of Parents/Guardians
One Parent Family
Two Parent Family
Primary Language at Home
American Sign Language
English
Spanish
Number in Household
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 Supplemental Security Income (SSI)?
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
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
Answer all required questions for the child/children you are submitting the application for. If your child has an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP), or any chronic conditions such as asthma, diabetes, seizures, allergies, or dietary restrictions, please provide that information as requested. Be sure to upload supporting documents in the upload attachments section.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
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)
Preschool for 2025 - 2026 School Year
Free Preschool for Children Ages 3 - 5
Preschool for 2025 - 2026 School Year
Free Preschool for Children Ages 3 - 5
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd 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
After selecting "Save and Continue," you will be directed to the "Upload Document" screen. Here, please scan or take a picture of the required documents using your cell phone, computer, or laptop. Once you have captured the documents, proceed to upload them by following the on-screen instructions. After uploading the necessary documents, click on "Save and Continue" to complete the process. If you encounter any issues or have questions, please don't hesitate to contact us for assistance. Contact us at Breathitt County Head Start Centers- 606-666-8585, Lee County Head Start - 606-464-3140 or 3329 option 2, Wolfe County Head Start - 606-668-7879 or 7111 option 1.
Required information is missing, see above.