Your application is not complete until you have filled out both sections. The general family information and the Selection Criteria. Not finishing the Selection Criteria MAY LEAD TO A DELAY IN PROCESSING your application. Program Requirements: Must provide proof of residency of Stafford County, proof of income, original birth certificate, immunization records, school physical and dental examination.
Parent/Guardian
Completing an application for the program does not guarantee acceptance. Please be sure to answer all questions before submitting, as missing information will delay processing your child's application. An Interview is required as part of the application process.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
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.
Lives with Family
Yes
No
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
American Sign Language
Amharic
Arabic
Bantu
Bengali/Bangla
Berber
Berber
Chinese
Creole
Danish
Dari
Dinka
English
Farsi
French
Ga
Hausa
Hebrew
Hindi
Japanese
Khmer
Kirundi
Korean
Mandarin
Moroccan
Ndebele
Pashto
Persian
Pidgins
Polish
Portgese
Punjabi
Q'eqchi
Russian
Somali
Spanish
Spanish
Swahili
Tagalog
Twi
Ukrainian
Urdu
Uyghur
Vietnamese
Yoruba
Other Language Proficiency
Little
Moderate
None
Proficient
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
Employment Status (Required)
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship (Required)
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody (Required)
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
PROOF OF ADDRESS
The following documents will be accepted as proof of residency for Stafford County.
*A lease or a mortgage statement (Primary)
*A current utility bill, water, electric or gas (secondary)
*Photo ID with current address
*Medical bill
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
Click here
to find a provider in your area.
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Suffix
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.
Lives with Family (Required)
Yes
No
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
American Sign Language
Amharic
Arabic
Bantu
Bengali/Bangla
Berber
Berber
Chinese
Creole
Danish
Dari
Dinka
English
Farsi
French
Ga
Hausa
Hebrew
Hindi
Japanese
Khmer
Kirundi
Korean
Mandarin
Moroccan
Ndebele
Pashto
Persian
Pidgins
Polish
Portgese
Punjabi
Q'eqchi
Russian
Somali
Spanish
Spanish
Swahili
Tagalog
Twi
Ukrainian
Urdu
Uyghur
Vietnamese
Yoruba
Other Language Proficiency
Little
Moderate
None
Proficient
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
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody (Required)
Yes
No
Provides Financial Support (Required)
Yes
No
Teen Parent
Yes
No
Family Information
VERIFICATION OF INCOME
Provide all applicable documents
• SNAP – Copy of your most recent statement.
• TANF - A copy of your monthly statement
• SSI - A copy of your most recent letter for SSI showing your monthly benefits.
• 1040 Tax Form for each parent in the household.
• W-2 for each parent in the household.
• Seasonal Workers - provide a statement from their employer.
• Income means gross cash income and includes earned income, military income (including pay and allowances), veterans’ benefits, unemployment compensation and Child Support
Email to headstart@staffordschools.net
The above information is true to the best of my knowledge. If any part is false, my participation in this agency’s program may be terminated.
Number of Parents/Guardians (Required)
One Parent Family
Two Parent Family
Relationship to Participant(s) (Required)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home (Required)
American Sign Language
Amharic
Arabic
Bantu
Bengali/Bangla
Berber
Berber
Chinese
Creole
Danish
Dari
Dinka
English
Farsi
French
Ga
Hausa
Hebrew
Hindi
Japanese
Khmer
Kirundi
Korean
Mandarin
Moroccan
Ndebele
Pashto
Persian
Pidgins
Polish
Portgese
Punjabi
Q'eqchi
Russian
Somali
Spanish
Spanish
Swahili
Tagalog
Twi
Ukrainian
Urdu
Uyghur
Vietnamese
Yoruba
Is another language being acquired or learned at home?
Yes
No
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)
Yes
No
Is your family receiving Supplemental Security Income (SSI)? (Required)
Yes
No
Is your family receiving services from WIC? (Required)
Yes
No
WIC ID (if applicable)
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps? (Required)
Yes
No
Is at least one parent/guardian an active duty member of the United States military? (Required)
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Gender (Required)
Female
Male
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
American Sign Language
Amharic
Arabic
Bantu
Bengali/Bangla
Berber
Berber
Chinese
Creole
Danish
Dari
Dinka
English
Farsi
French
Ga
Hausa
Hebrew
Hindi
Japanese
Khmer
Kirundi
Korean
Mandarin
Moroccan
Ndebele
Pashto
Persian
Pidgins
Polish
Portgese
Punjabi
Q'eqchi
Russian
Somali
Spanish
Spanish
Swahili
Tagalog
Twi
Ukrainian
Urdu
Uyghur
Vietnamese
Yoruba
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage (Required)
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Medicaid Number
Doctor/Medical Home
779th medical group
AAA Pediatric
Aaron Figler OD
Aaronson, Allen MD
ABC pediatrics
ABC Pediatrics, Fayetteville, GA
Abdussalam Cheema
Above and Beyond
Access Eye Centers
Advanced Care For Women
Aguilar, Edwin F., MD
Ahmad, Naeem MD
Akpinar childrens clinic
Alan Wong
Albert Einstein pediatric amblu
Alexandria pediatric center
Alice Han MD
All About Women
All Pediatrics Lakeridge
All Pediatrics of Lorton
Allegretti, Roxanne
Allergyand Asthma center of Fre
Allina Health Bloomington Clinic
America's best eyeglasses
Amin, MD Shoeb
Aquia Family Medical Center
Aquia Park Access Eye
Aquidneck pediatrics
Arbabi, MD Niloofar
Arnold, Jacqueline
Ascent Audiology & Hearing
Ashbrook Pediatrics
Audiology At Fontaine
Augusta Pediatrics
Auril Caudill MD
Avanti Garde urgent care
Ayanna M cgay MD
Aylette Medical Center
Azar, Jana
Azka
B. Adrian Biscombe, OD
Balance and ear center
BaylorScott &White
Bayside Primary
Bazemore,Marlet
Beckley Pedatric Assoc
Beckman, Kathleen
Berezuk Kimberly MD
Best Vision PLLC
Bethesda Naval
Biscombe, Adrian, MD
Blaine, Anke, CPNP
Blair Ryland DO
Bommasawi, R. MD
Bon Secours Hanover peds
Bon Secours Mechanicsville
Bon Secours Medical Group
Boulevard Center Pediatrics
Boykin
Bradshaw, Ann MD
BRISTOW PEDIATRICS
Brock
Brock, Lee R MD
Brown , Dana
Brown, Robin RN
Bui-Platten, OD Oanh
Burke peds
Burns, Jeanne RN, CPNP, MSN
Butera, Tina MD
Cao,Lynn MD
Capital Arear pediatrics
Capital Womens Care
Carenow Urgent care
Carilon clinic
Carlos Cruz MD
Caroline Christian Health Center
Carolyn Boone MD
Carrie Edwards
Casa Pediatrics
CCI Greenway refuge
Centercare Family practise
Central VA health services
Central VA OB-GYN
Centro de diagnostico medico
Century Pediatrics
Century Pediatrics
Century Pediatrics, Inc.
Chakurkar MD
Chancellor Pediatrics
Charleston Area medical Center
childfind
Children and Adolescents Clinic
Children First Inc.
Children's clinic of Fredericksb
Children's health center
Children's Hospital UVA
Children's medical care
Children's National
Children's Ophthalmology
Childrens Health PC
Childrens Health PC
Childrens healthcare of NVA
Childrens Hearing and Speech Cen
Childrens pediatricians and asso
Childrens Physcians
Childrens Primary Care Medical g
Childress, J. Micheal
China Global Pediatrics PC
Chippenham pediatrics
Chism, Rita C. CNP GC Pediatric
Christian Health Center Frederic
Christiana Care Pediatric Partne
Christopher Leffler MD
Christopher Leffner, MD
Clark, Mark Allen
Clarke, Jennifer
Clinica Familiar de Arlington
clinica health family
CMA Pediatrics
Coa
Coastal childrens clinic
Coastal pediatric assoc
Cochran, Amy MD
Coles county Health Dept
Colonial Forge medical ctrL
Comfort Dental
Comm Health Ctr of the Rappahann
Commonwealth Ear, Nose + Throat
Commonwealth Pediatrics
commonwealth perinatal services
Communicare Health centers
Community Health Center
Complete Care for Kids LLC
Coney Island Hospital
Cooks Children's
Courtney, MD (Kaiser)
CPFP
Crestwood Ped Assoc
Cruz, Carlos A. M.D.
Culpeper Head Start
Culpeper Hearing center
culpeper medical clinic
CVHS
CVS Minute clinic
Cynthia Zeller, CRNP, DNP
Cyrelda R. Fermin MD
Dancel, Rosario G. MD
Daniel Trementozi MD
Dao, Jennifer MD
Dash, Nariman, MD
David Walters MD
David, M. Herr, OD
Davis Medical ctr
DC Health
Deborah Dunlap
Deborah Howard
Derby Pediatric
Derek M Evans, OD
Diana Tran
Dixon, Christina
Doctor-Jose, Nora MD
Dominion Hills family dentist
Dr Eric Amakan
Dr Franz
Dr Gohel
Dr Lee Pediatrics
Dr Singh
Dr Uchella
Dr. Jay and Stephanie Lee
Dr. Konstantinos Petinos
Drs. Jay & Stephanie Lee, OD
Duhart, Harold, MD
Dumfries Health Center
Dupont Peds
Dzibela, Tracy OD
E. Silverstein, MD (VCU)
Ear Nose &Throat &Facial ctr of
Ear Nose&Throat Assoc
Early Head Start
Early, Steven M.D
East end pediatrics PC
East West Pediatrics
Easter Seals of Georgia
Eastern Illinois Area Of Special
Easy Care Urgent Care
ECNV
Eleia Reyes MD
Elizabeth Hopewell NP
ElMauan, Mohammad MD
Embracing Health
Embrey Mill Primary/Urgent Care
ENT & Facial Plastic Surg F'burg
Ernest Quaye MD
Eugenia Mathurin Annang MD
Evan Silverstan MD
Evan Silverstein MD
Evans, OD, Dereck
Eye Care Doctors of Optometry
Eye Consultants of Northern Va
F'burg Christian Health Center
Fairfax county health department
fairfax county schools
Fairfax schools audio services
Fall Hill Pediatrics
Falls church urgent care
Family health Ctrs San Diego
Family med at colonial forge
Family Medical Care of NYPC
Family medicine pyhsician
Family Optometric Association
Family practise Woodbridge
Fauquier ENT Consultants, PLC
Feinstein
Fermin Cyrei MD
Ferry Farm Health and Wellness
Fields Family Eye Care
fort Belvoir Community hospital
Fort Belvoir Pediatric Clinic
Fowler, Darlene, O.D.
Francis Buckman, MD
Francis C. McVeil, OD
Franconia pediatric assoc
Franconia Pediatrics
Frankel, Holly DPNP
Frayna-Manlapaz, Christina M.D,
Fred Christian Health center
Fred Head Start
Fred Health department
Fredericksburg Christian Pediatr
Fredericksburg Eye Care
Fredericksburg Health Dept
Fredericksburg Pediatrics
Front Royal Family practice pc
Ft Belvior
Ga Dept of Public Health
Gabriel Lee MD
Ganesh MD, Lalitha
Garrisionville urgent care
GC Pediatrics
Generation of women
Generations of children
Germanna Community College
Gerona, L. MD (Naval Clinic)
Giannuzzi, Betsy MSN CRNP
Giant
Ginger Beecher NP
Ginger Richardson, CNP
Gonzales, George
Goodlett, Allison
GPW Health Center
Greater Prince William health ce
Grossett, OD Sandra
Grote, Mary Jo PhD
Gupta, Paroni NPC
Habib, Farangis MD
Hampton Rds ped
Hannah Twoney
Hartmut Doenwalt MD
Hathorne Eye Care LLC
Health And Wellness Of Louisa
Health Insurance Coordinator
Healthworks of NVA
Hearing and Health care ctr mana
Hearing center of excellence DOD
Henrdon Medical Care
Henrico Pediatrics
Herron, MD Meriada
Hillendale Medical
Hiremath, MD. U
Hispanic American Pediatric Asso
Hoadly Medical Care
Howard University Pediatric Dept
Hulebak Samantha MD
Innovatus Care
Inova
Inova Cares Clinic For Children
Inova Pediatric Encology Fairfax
INT health clinics
Ipakchi, Ramin MD
J. Corrales, MD
Jackie Gilliard, MD
James Elias OD
Jean Laurore MD
Jeanne Burns, RN, CPNP, MSN
Jenese Mancini
Jennifer Falcon MD
Jennifer White MSCAA
Jessie Brutus MD
Jocelyn D. Trent MD
John Wizerbzi
Johnson Health Center
Johnson, William B., MD
Jollan Rhodes MD
Joseph Walde MD
Joseph, George
Jovanna Mickle PA
Kaiser Camp Springs
Kaiser of Stafford
Kaiser Optometry Springfield
Kaiser Permanente
Kaiser Permanente
Kaiser Permanente Manasas
Kaiser Permanente Woodbridge
Kaiser Permanente Woodbridge
Karen Mason FNP-C
Kathleen O Brian MD
Kazni, Rumana
Kekulah Sonnie CRNP
Kendra Halepaska
Kendra Halepaska
Kenneth Kim Pediatrics
Kenneth Tilghman
Kevin Dixon
Keyesville Pediatrics
Khan Pediatric Care
Kharbanda, Monica
Kharbanda, Nirmala
Kid Med
Kids First Pediatrics
Kidschoice Pediatrics, P.C.
kidsville pediatrics
KIDSWELLNESS PEDIATRICS
Kilby Pediatrics
Kim. David Dr. DDS
Kimberly Mc Donald FNP-C
King George Pediatrics
Kisha Wilson MD
Kost-Phillips, MD
Kumar, Krishnan S. M.D.
L. Alvarado
labcorp
Ladysmith Medical Center
Lakeridge Pediatrics
Lapeer Peds
Lee Brock MD
Lee's Hill Family Practice
Lee's Hill Medical Center
Leiser, John MD
Leroy Owens MD
Lesly Dejarnette PA-C
Liberia Dental
Lion Club "Eye Glasses voucher "
Lion's Club
Liu, Shinte, MD
Loving Tamara
Lowey MD
Madiraju, Krishna
Malik Shahab, MD
Manassas Hearing Center
Manassas Pediatrics LTD
Manchester Pediatric assoc
Mancini, Pamela MD
Mandy Williams Au.d CC-A
Mandy Williams AUD
Mansouri, Arash, MD
Map clinics
Marcus, Jessica
Marie L. Nazario, MD
Marie Sacoto
Marissa Moultrue
Mark Salerno MD
Martin pediatric care
MaRY wASHINGTON hEALTHCARE
Mary Washington Hospital
Mary Washington medical group
Mary Washington Pediatric
Mary Washington Primary Care
Mary washington Uni.
Maryland Childrens health ctr
Maryland dept of Health
Maryland WIC
Mass General Hospital
Massachusetts General Hospital
Mattapan Comm Health
May, Hettler and Finney, OD, LLC
McGary, Yvonne
MCQUIRE aIRFORCE CLINIC
MCV pediatrics
MDS Pediatrics
Medicaid
Medicaid Helpline
Medical Access
Mednorth Center
MedStar Health
MEDTOX LAB
Meghan Ellden
Metropolitian pediatrics
Millenium Medical Corp
Mirini Kim CPNP
MLV Lab
Mohamad Sami Jaafar, MD
Monterey County Laurel Family Pr
Mosaic Dental
Mose Matthew
Moss Clinic
Moss, Judith, MD.
MT View medical group
Muhammed Ali Kahn MD
Multi Specialty Group Spotsy
Munhyang Lee
MWMG Pediatrics
My Eye Dr.
My Kids and adol care
Nair, Santhi MD
Nancy Goeden MD
Nancy Goeden, MD
Naval Health Clinic Quantico
Navel Health clinic
Neha Soni
Neighborhood Health
New Beginings OBGYN
New Hanover Health dept
New York depart Health
Newport News peds
Next Care (White Oak Road)
Next Care Dumfries
Next Care Gateway
Next Care Urgent Care
Nextcare Urgent (Garrisonville)
Nextcare Urgent Care
Nguyen, Duong T. D.O.
Nicholson, Elsa RD
Nidhiry, Gracy E.
Nira Garony
Nirai Gandhi
Noori, Alice MD
Nora Jose MD
North shore pediatrics
Northern Virginia Family Practic
Nortons's children medical
Nova pediatrics
O Obasanjo
O'Brien, Julie MD
O'Meara, Aaron PA
Olde town pediatrics
Omidvar, Jemal, MD
Optimum Care, LLC
Optometry Colonial Forge
optometry of woodbridge
Osborne, Kelly CPNP
Oscar Benavides MD
P.L. Physicians INC, Pediatrics
Page Healthcare Associates
Pamela Mancini
Parent Resource Center
Park Pediatric
Park slope peds faculty practice
Parkway pediatrics
Partnership Event Community
Patient First
patient first
Patient First Lake Ridge
Patient First Manassas
Patterson MD
Peach State Pediatrics, P.C.
Ped spec of va oncology
Ped specialist of VA develop
Pedi Place @ Westover Hills, PA
Pediatric & Neurology Clinic UVA
Pediatric Adolescent med
Pediatric Assoc INC
Pediatric Assoc of Alexandria
Pediatric Associates
Pediatric Associates of Charlott
pediatric associates of springfi
Pediatric Care of Northern VA
Pediatric Clinic UVA
Pediatric Clinical Services LTD
Pediatric group practise
Pediatric Healthcare
Pediatric Lung Ctr
Pediatric Ophthalmology Fairfax
Pediatric partners MD
Pediatric Partners of Stafford
Pediatric Physcians Group LLC
Pediatric Place of Tampa
Pediatric Practice
Pediatric Practice PC Chantilly
Pediatric Primary Care
pediatric specialist of nuerolog
Pediatric Specialists
Pediatricare of Northern Va. P.C
pediatrics at Orange
Pediatrics at Oyster
Pediatrix Audiology Services
Pediatrix Cardiology
Pedsplus primary care
Peidmont Pediatrics
PEIDS
Pennisula Institute for Comm Hea
Pennsylvania Depart Health
Petersburg healthcare alliance
Piedmont Pediatrics
Pine grove peds
PL Physicians, INC
PL Physicians, Inc.
PL Physicians, Inc.-Pediatrics
Plainfield ped
Potomac Ear Nose and Throat
Potomac Falls ped dentistry
Potomac Pediatrics
Powell Timothy MD
Pratt ent
Pratt Family Practice/Stafford
Pratt Healthcare Pediatrics
Pratt king George
Pratt OBGYN
Pratt Pediatrics
Pratt Pediatrics Spotsylvania
Preferred Pediatrics
Preferred Pediatrics
Preferred Pediatrics
Premier Eyecare
premier pediatrics of Manassas
Primary & Urgent Care
Primary and Urgent Care
Primary and Urgent Care
Primary care assoc CA
Prime Care Family Practice
Prince William Area Free Clinic
Prince William HD
Prince william hospital
Prince William ped care
Prince William Pediatrics
Princeton Peds
PW pediatrics
Quantico Clinic
Queens Pediatric Assoc
Quest lab
Rafael Nunez MD
Rajan, Rajith
Ramin Ipakchi MD
Rappahannock Area Health Dist.
Rappahannock Family Healthcare
Rappahannock Pediatric Assoc
Rappahannock United Way
rappahanock womens health ctr
Rapphannock Family Physicians
Raymond Jones MD
Reid, Yolanda MD
Rhanda Savania MD
Rhonda Savania MD
Riazi, NP R.
Rica Pediatrics
Richard Bennett MD
Richman, Suzanne, MD
Richmond pediatric Assoc
River Regional clinic
River side Pediatrics
Riverdale Park Pediatrics
Robert Feld MD
Robert Kane
Roberts Laurie CCC-A
Rockville Pediatric Dental
Rocky Run Family med
Rodriguez, Gloti
Rose, Sonia J MD
rt news pediatrics
Sacoto Pediatrics PC
Sam Baker OD
Sameera Rentia MD
Sandra Bell
Sarah Cheema MD
SCPS Transportation
Sebastian, MD Melinda
Sentara Hospital
Sentara Pratt Medical Group Peds
Sentara Spring Creek Family med
Sentera Family Med
Seven Corners Medical and Dental
Shabana Qureshi MD
Southern Med Pediatrics
Stafford HD
Stafford R.I.S.E
Stafford schools
Susan Steinberg AUD
Tajav DO
Taylor MD
Tonasha Johnson
Toomari MD
tpg
UN Immigration
US deoartment of stae
UVA pediatrics
vAN dORN PEDIATRICS
VCU ENT/OPHTHALMOLOGY
VCU Health System
VCU MEdical Center
Verne Rochard MD
Virginia Department of Health
Virginia ear nose and throat
Virginia Eye Institute
Virginia Eyecare Center
Virginia Family Nurtrition Prgm
Virginia Kockler MD
Virginia Pediatrics
Virginia Vision Associates
Visionworks
W Cook MD
W&A Pediatrics
Wake Forest Health Network
Waldorf Pediatrics
Walmart National Vision Center
Walters Reed
Wan Soo Lee
Wan Soo Lee MD
Warrenton Pediatrics
Watoto Pediatric /Adolescent
Wayne Shaia MD
Welham, Jenny MD
Well care health/mega lab
Well now urgent care
Wellspring Health Services
West End Peds
Whang, Daniel T. O.D.
Whang, O.D. Daniel
WIC
Wilderness Medical Center
wilkerson pediactric clinic
Wilson, Jennifer FNPC
Win, Sein MD
Winchester Medical Center Lab
Woodbridge Pediatrics, LTD
Wu, Jason M.D.
WVU Health care
Wynn, Jeffrey I Dr.
Youn &Mannan LLC
Ypsilanti health center
Yum Pediatrics
Zapata-de-Perez, Norma MD
Zhao Wang MD
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Agency
ChildFind
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Google
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Healthy families
McKinney Vento
News paper
Past Parent
PEIDS
Poster
Reapplying
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SCPS
TV ad
WIC
Food Allergies/Exceptions (Required)
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No
Food that can't be eaten
Other Allergies (Required)
Yes
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List Allergies
Working with ChildFind?
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Location Preferences
Which program are you applying for? (Required)
EHS 2024-2025
Head Start/VPI 2025-2026
Location Preference
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3rd Location Preference
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Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Siblings
Are there other children in the family?
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PLEASE FILL OUT EVERY QUESTION FULLY; BLANKS MAY LEAD TO A DELAY IN PROCESSING. PROOF OF INCOME IS REQUIRED BEFORE THE APPLICATION CAN BE PROCESSED. Please take a picture with your phone of the first two pages of your 1040 (most recent Tax Return) and email to headstart@staffordschools.net Fill out the Selection Criteria page at https://forms.gle/84xmbdHEbVuehxrH8 For more information or for help filling out this application, call the Head Start Office at (540) 368-2559, or Fax (540) 368-1978. The Stafford County School Board does not unlawfully discriminate against any person on the basis of: race, sex, age, color, religion, national origin, political affiliation or disability. Inquiries regarding non-discrimination should be directed to the Executive Director of Human Resources, Stafford County Public Schools, 31 Stafford Ave., Stafford, Virginia 22554, Phone (540)658-6560, FAX: (540)658-5950. Head Start does serve children with disabilities, with income eligible children taking priority. Reasonable accommodations upon request. Completing an application for the program does NOT guarantee enrollment.
Required information is missing, see above.