Please provide the following information so that we may contact you to discuss enrolling your child in our Head Start program. The Head Start Program is a free, comprehensive child and family development school readiness program available to income eligible families in Lake and Geauga County.
Parent/Guardian
If you had a child in our program previously you may already be in our system. If you get a message stating that you cannot apply online please call the center. Be sure to mention that you attempted to apply online but were unable to. Have a great day!
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 (Required)
Opt In for Text Messages
Yes
No
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.
English Proficiency (Required)
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Chinese
Croatian
English
French
German
Gujrati
Haitian-Creole
Hebrew
Hindi
Italian
Lithuanian
Other
Palauan
Portuguese
Spanish
Spanish
Swahili
Vietnamese
Yiddish
Address
Is your family experiencing homelessness?
Yes
No
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
Family Information
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
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 under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Child (Applicant)
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Free Preschool for Children Ages 3 to 5!
Free Preschool for Children Ages 3 to 5
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
Thank you for your interest in Lake Geauga United Head Start! Once you've completed this questionnaire, please click submit. We will call you within the next 7-10 business days to answer all of your questions and to complete the application process.
Required information is missing, see above.