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)
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
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
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
Address
You must provide your current living address. If the living address is different from the mailing address, provide the secondary address in the mailing address section.
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
Additional Parent/Guardian
Only complete this section if the Secondary Adult is currently living in the home, being supported by the same income, and related by blood, marriage, or adoption; or are the child’s authorized caregiver or legally responsible party.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
Lives with Family
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Bengali
Chinese
Croatian
English
Fijian
French
German
Haitian-Creole
Hebrew
Hindi
Italian
Kurdish
Mixtec
Native North American/Alaska Native
Nepali
Palauan
Patois
Portuguese
Quichean
Russian
Spanish
Spanish
Swahili
Tagalog
Thai
Urdu
Vietnamese
Wolof
Yiddish
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
Yes
No
Teen Parent
Yes
No
Family Information
Family includes all persons living in the same household who are supported by the child’s parent(s)’ or guardian(s)’ income; and are related to the child’s parent(s) or guardian(s) by blood, marriage, or adoption; or are the child’s authorized caregiver or legally responsible party.
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)
Answer all required questions for the child/children you are submitting the application for. If your child has an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP), or any chronic conditions such as asthma, diabetes, seizures, allergies, or dietary restrictions, please provide that information as requested. Be sure to upload supporting documents in the upload attachments section.
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Birthday (Required)
Location Preferences
Which program are you applying for? (Required)
Early Head Start 2025 - 2026
No Cost Preschool for Children Ages 6 weeks to 3 Years
Head Start 2025 - 2026
No Cost Preschool for Children Ages 3 to 5 Years
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
Siblings
Are there other children in the family?
Add a Sibling
You have one last step after you select save and continue. The next screen is the "Upload Document" screen. Please, scan or take a picture of the documents and upload them using your cell phone, computer or laptop. Select "Save and Continue". 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.