Welcome to HCS Head Start, Inc.!

EDUCATING children. SUPPORTING families. BUILDING healthy communities.

Thank you for your interest in HCS Head Start, Inc. We're excited that you're considering our program for your family. Please complete all required fields to the best of your ability. Submitting this form lets us know you're interested but does not guarantee enrollment. A friendly member of our Enrollment Team will reach out for additional information.

Important: If any member of your family has previously applied to HCS Head Start, please stop completing this application and contact us at (413)-417-7779 or enroll@headstart.org before proceeding.

Head Start and Early Head Start support children from birth to age five, as well as pregnant individuals. Enrollment is based on eligibility, child and family needs, and available openings. While families are generally income-eligible based on Head Start guidelines, we also reserve a limited number of spots for families who may be over income. All families are welcome and encouraged to apply.

HCS Head Start offers part-day early childhood programs at no cost to eligible families. Full-day options are available for parents who are working, attending school, or participating in another full time service need. Families interested in Child Care Financial Assistance should contact our Enrollment Department directly.

After you submit this form, an Enrollment Advisor will contact you to schedule an intake appointment and help guide you through the application process for your child(ren) or pregnancy services.

Complete this section for parent/guardian. List the Head of Household first.

First Name (Required)

Middle Name

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.

Lives with Family (Required)

English Proficiency (Required)

Other Language

Highest Grade Completed

Employment Status

Child's Relationship (Required)

Custody (Required)

Provides Financial Support

Teen Parent

Preferred Communication

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

Please list a Secondary Adult only if they reside in the household and are supported by the Primary Parent's income, and are 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?

First Name (Required)

Last Name (Required)

Birthday (Required)

Gender

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.

Lives with Family (Required)

English Proficiency (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Number of Parents/Guardians (Required)

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? (Required)

Is your family receiving Supplemental Security Income (SSI)? (Required)

Is your family receiving services from WIC? (Required)

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps? (Required)

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?

This section is only for children who are applying to the program. Please include each child you would like to be considered for enrollment. Do not include siblings who are not applying.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Lives with Family

Primary Health Coverage (Required)

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? (Required)

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

What Happens Next? After you submit this form, you will receive an email confirmation. A member of our team will contact you within two business days to schedule your intake appointment. Please be sure to keep your contact information up to date so we can reach you with important updates. The phone numbers and email addresses you provide will only be used to communicate with you about your child’s application or enrollment status.

Required information is missing, see above.

Welcome to HCS Head Start, Inc.!

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings