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Thank you for your interest in our Head Start/Early Head Start Programs. Any family may apply, but priority is given to those with limited income and children with special needs, including children with severe disabilities. Please fill out the application to the best of your ability. If you have already applied for services and want to update your application, please contact your local center. Repeat submissions will be rejected by the system. We welcome all children between the ages of 0-4 years old; (4 or under as of 8/15/2020). Our services include school readiness, health & nutrition, social & emotional development, mental health and family services.

Please complete the following information about the primary parent/guardian of the child to be enrolled.

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

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

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Teen Parent

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

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

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

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Teen Parent

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Primary Language at Home

Number in Household

Number in Family

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

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

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

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Primary Health Coverage

Doctor/Medical Home

Dental Coverage

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

1st Location Preference

2nd 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

Please click "submit" to finalize your application. An Enrollment staff member will be contacting you soon for a follow up appointment. Please have the following documents ready for the follow up: 1. Proof of income - 2019 Income Tax Forms or W-2's; OR all check stubs from the prior month, PLUS documentation from any addition income means (if applicable) OR TAN-F Cash Assistance Benefits/Families First Child Care Certificate OR Supplemental Security Income (SSI) 2. Proof of address (utility bill, phone bill, etc.) 3. Immunization Record (Shot Record) 4. Birth Certificate (verification of age) 5. IEP/IFSP (if applicable) 6. Court ordered paperwork such as custody papers, restraining orders, etc. (if applicable). If you have any questions, please feel free to contact us at (615) 806-9161 or (615) 854-5837. Thank you.

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