Apply Online

Thank you for your interest in the NCCAA's Birth to Five Head Start Program. Please fill in every space on the application, as applicable. If you are listing a secondary/other adult you MUST provide a phone number and address for this person. If you've previously applied for the program and your information is in the database you will not be able to complete the Online Pre-Application; however, you can go to our agency website (nccaatx.org) to print out an application or fill one out at our office. Additionally, if you are applying for the Expectant Women's Program (Pregnant), Please list the "Child (Applicant)" name as Unborn with your last name. Under the Location Preferences drop down select Expectant Women's Program. Once the application is submitted an interview will need to be conducted and the supporting documents will need to be submitted to our Enrollment Center. Please note the application is not complete until the supporting documents and interview are complete and submitted.

First Name (Required)

Middle Name

Last Name (Required)

Nickname

Birthday (Required)

Gender (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 (Required)

Opt In for Text Messages

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.

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Please complete address with: number, name of street, zip code, and county PLEASE KEEP IN MIND THAT WE ONLY SERVICE NUECES COUNTY. IF YOU ARE NOT A RESIDENT OF NUECES COUNTY PLEASE VISIT https://eclkc.ohs.acf.hhs.gov/center-locator TO FIND A HEAD START NEAR YOU.

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

Please list anyone whom you wish to share your primary care giver duties with here; regarding the child(ren). This allows the person to sign documents and make decisions regarding the child(ren). Secondary Caregiver must live in the same home with the family. Significant others can be listed here.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender (Required)

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 (Required)

Opt In for Text Messages

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.

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

Please complete all fields

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home? (Required)

Number in Household (Required)

Number in Family (Required)

Gross Annual Income

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

Is your family receiving Supplemental Security Income (SSI)? (Required)

Is your family receiving services from WIC? (Required)

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

Is at least one parent/guardian an active duty member of the United States military? (Required)

Is at least one parent/guardian a veteran of the United States military? (Required)

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Insurance Number

Medicaid Eligibility (Required)

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

Dentist/Dental Home

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

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

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd 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

Thank you for applying for the NCCAA Birth to Five Head Start Program. You've completed the pre-application process; however, to complete the application, your supporting documents will need to be submitted to our Enrollment Center at 2526 Soledad St. Corpus Christi, Tx, 78416. Applications accepted Monday-Friday from 8:15am to 11:45am and 1:15pm to 4:30pm. If you have any questions or concerns please contact us at 361-880-4141 You can also submit your documents to our Robstown location if it is closer to you at Salazar Head Start 400 W, Ligustrum Robstown, Tx, 78380 (Phone: 361-808-4997)

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings