This is only a Pre Application, after submitting this Pre-App you will receive a phone call to schedule an in person interview and you will be instructed on what paper work you should bring or upload prior to your appointment.
Parent/Guardian
First Name (Required)
Middle Name
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.
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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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
Primary Language at Home
American Sign Language
Arabic
Asian
Chinese
English
French
German
Gujarati
Hebrew
Japenese
Punjaki
Serbian
Spanish
Urdu
Number in Household
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
WIC ID (if applicable)
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Location Preferences
Which program are you applying for? (Required)
Head Start
All Locations Except Farrell and Greenville (dob: 9/1/18-8/31/20) (Lakeview dob: 7/1/18-6/30/20)
Head Start
All Locations Except Farrell and Greenville (dob: 9/1/19-8/31/21) (Lakeview dob: 7/1/19-6/30/21)
Early Head Start
Pregnant Moms and Children Birth to 2 1/2
Pre-K
Income up to 300% of Poverty Guidelines (dob: 9/1/19-8/31/21)
Pre K
Income up to 300% of Poverty Guidelines (dob: 9/1/18-8/31/20)
Head Start
Farrell and Greenville Locations only (dob: 9/1/18-8/31/20)
Head Start
Farrell and Greenville Locations only (dob: 9/1/19-8/31/21)
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
Required information is missing, see above.