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EARLY HEAD START & HEAD START PRE-APPLICATION - Early childhood education services for expectant women and children under age 5 and their families
For more information email: ehs-hsregistration@clarke.k12.ga.us

First Name (Required)

Middle Name

Last Name (Required)

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.

SSN (Required)

Race (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

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)

Middle Name

Last Name (Required)

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.

SSN

Race (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home? (Required)

Number in Household (Required)

Number in Family (Required)

Gross Annual Income (Required)

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)

WIC ID (if applicable) (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? (Required)

Is at least one parent/guardian a veteran of the United States military? (Required)

Add Emergency Contact

First Name (Required)

Middle Name (Required)

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

SSN (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language (Required)

Other Language Proficiency

Primary Health Coverage (Required)

Other Coverage (Required)

Insurance Number (Required)

Medicaid Eligibility (Required)

Medicaid Number (Required)

Doctor/Medical Home (Required)

Dental Coverage (Required)

Dental Coverage Number (Required)

Dentist/Dental Home (Required)

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

Thank you for your application for Early Head Start and Head Start services.

(1) You will be directed to the Clarke County School District (CCSD) registration site to register. You must write down and save your online registration identification number

(2) Click on the link to schedule your eligibility appointment: https://calendar.app.google/j3dgBSX5f3RdzbLR6 (3) You will need to bring the following documents to your appointment:

o CCSD Online Registration (OLR) Number
o Proof of address (2 documents) (Mortgage, lease, rental agreement, or recent utility bill; if proof of residence is not the legal parent/guardian name, additional paperwork is required)
o Proof of income for previous 12 months (W2’s; Form 1040; paycheck stubs; documentation of public benefits-Supplemental Security Income (SSI), TANF, Foster Parent Payments; unemployment compensation, military pay; child support; scholarships; etc.)
o Proof of birth or pregnancy (Certified Birth Certificate, proof of pregnancy)
o Parent’s photo ID
o Proof of Guardianship (if child is adopted, in foster care, or living with someone other than a birth parent)
o Copy of the child’s Social Security Card or Waiver (A parent or guardian who objects to the incorporation of the social security number into the school records of a child may have the requirement waived by signing a statement objecting to the requirement. – O.C.G.A 20-2-150).

If you have any questions about your application, please contact Marsha Hawkins at ehs-hsregistration@clarke.k12.ga.us .

Disclaimer: The Early Head Start and Head Start programs are grant funded. Services are contingent upon the Clarke County School District receiving sufficient grant funds and cannot be guaranteed. Services are not guaranteed for all applicants due to limited enrollment capacity. No fees are charged for Early Head Start and Head Start services.

By submitting your pre-application you are certifying that all of the information provided is true to the best of my knowledge. If any part is false, my participation in the Early Head Start/Head Start program may be terminated and I may be subject to legal action.

The information you have provided will be held in strict confidence within the school district and is accessible to you during normal business hours upon written request in accordance with Board of Education Policy JR, Student Records.

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