Apply Online

All fields on this section of the application need to be completed with accurate information. This information is required by STEPS Head Start for your child to be considered for enrollment. The Primary Adult is the custodial parent/guardian.

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.

Race (Required)

Hispanic (Required)

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

All fields on this section of the application need to be completed with accurate information. This information is required by STEPS Head Start for your child to be considered for enrollment.

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

All fields on this section of the application need to be completed with accurate information. This information is required by STEPS Head Start for your child to be considered for enrollment. The Secondary Adult should be the second custodial parent/guardian that is related by blood/ marriage/adoption, if no second parent/guardian is present leave this section blank.

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.

Race

Hispanic

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

All fields on this section of the application need to be completed with accurate information. This information is required by STEPS Head Start for your child to be considered for enrollment. The Number in the family should include ONLY the Primary Adult, Secondary Adult, and children of those adults (brother/sister, step-siblings, half-siblings, adopted/foster siblings). DO NOT include other family members living in the home.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Number in Household

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?

Add Emergency Contact

All fields on this section of the application need to be completed with accurate information. This information is required by STEPS Head Start for your child to be considered for enrollment. The Child is the participant you are enrolling in STEPS Head Start.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race (Required)

Hispanic (Required)

Lives with Family

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Other Coverage

Insurance Number

Medicaid Eligibility (Required)

Medicaid Number

Doctor/Medical Home (Required)

Dental Coverage

Dental Coverage Number

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?

Child taking any Meds? (Required)

If yes, Name of Meds.

Applicant Chronic Health

Diagnosed illness

Abuse issues in the home?

Child or Spousal

Drug or Alcohol

Child prev. in EHS/H

Childs' sibling in EHS/HS

Death in home past 6 mths

Active Duty Military

Incarcerated parent?

One parent

Both parents

Diag./Suspected IEP/IFSP

If yes, Diagnosis/Suspect

Evaluated by

Date Evlauated

Which option works best: (Required)

Distance from center: (Required)

Someone to bring/pickup? (Required)

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

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings