Thank you for your interest in our Head Start/Early Head Start Programs. Our services include school readiness, health & nutrition, social & emotional development, mental health and family services. We welcome all children between the ages of 0-4 years old; (4 or under as of 8/15/2021). Please fill out the inquiry form to the best of your ability. If you have already applied for services and need to update your information, please contact your local center. Repeat submissions will be rejected by the system.
Parent/Guardian
Please complete the following information about the primary parent/guardian of the child to be enrolled.
First Name (Required)
Last Name (Required)
Birthday (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
Opt In for Text Messages
Yes
No
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.
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
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Location Preferences
Which program are you applying for? (Required)
2021-2022 Program Year
Ages 3 to 5 years. No Cost Preschool Program
2021-2022 Program Year
Ages 0 months - 34 months. No Cost , 6 Hr Early Childhood Program
1st Location Preference
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2nd Location Preference
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- Your Address
- Available Locations
Click a location on the map to see more info
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to find a provider in your area.
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?
Add a Sibling
Please click "submit." An Enrollment staff member will contact you soon regarding your inquiry. We will need the following documents to process your application: 1. Proof of income - 2020 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 TANF 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) 742-1113. Thank you.
Required information is missing, see above.