Thank you for your interest in our early childhood education programs. Please fill out as much of the information as possible. We will contact you if we have any questions or need additional information. NOTE: IF YOUR CHILD HAS ALREADY APPLIED FOR THIS PROGRAM, DO NOT CONTINUE COMPLETING APPLICATION, CALL (412) 488-2750
Parent/Guardian
First Name (Required)
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.
Lives with Family (Required)
Yes
No
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Asian Languages
Burmese
Chinese
English
French
Japanese
Korean
Mandarin
Native American Languages
Nepali
Other
Russian
Spanish
Spanish
Turkish
Unspecified
Vietnamese
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
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
Family Information
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
Arabic
Asian Languages
Burmese
Chinese
English
French
Japanese
Korean
Mandarin
Native American Languages
Nepali
Other
Russian
Spanish
Spanish
Turkish
Unspecified
Vietnamese
Number in Family
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
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?
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Is there anything else you want to tell us about your child?
Concerns for Development? (Required)
Yes
No
How did you hear about us (Required)
Community Event
Family Referral
Flyer
Internet Search
Other
Previously Enrolled Child
Referral
Staff Member
Location Preferences
Which program are you applying for? (Required)
HEAD START 2025-2026
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
Once we have received your completed application, we will be contacting you to provide proof of birth and income.
Required information is missing, see above.