If you have put in an application for the last 10 years you are already in our system and cannot create a new application. You will need to fill out a paper application and send it to Community Action or you can make an appointment to do an application over the phone. You can make the appointment on our website.
Parent/Guardian
First Name (Required)
Last Name (Required)
Suffix
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
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
Albanian
American Sign Language
Arabic
Creole
Czechoslovakian
English
Ewe
Filipino
French
German
Gujarati
Hindi
Kirundi
Liberyian
Malayalem
Mandarin Chinese
Mano
Mina
Napoli
Nigerian
Oromo
Other
Pular
Punjabi
Spanish
Swahili
Tagalog
Telugu
Urdu
Vietnamese
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 (35 hours/week or more)
Part-time (Under 35 hours/week)
Retired or Disabled
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
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
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Suffix
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
White
Hispanic
Yes
No
Other Language
Albanian
American Sign Language
Arabic
Creole
Czechoslovakian
English
Ewe
Filipino
French
German
Gujarati
Hindi
Kirundi
Liberyian
Malayalem
Mandarin Chinese
Mano
Mina
Napoli
Nigerian
Oromo
Other
Pular
Punjabi
Spanish
Swahili
Tagalog
Telugu
Urdu
Vietnamese
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 (35 hours/week or more)
Part-time (Under 35 hours/week)
Retired or Disabled
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
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
Albanian
American Sign Language
Arabic
Creole
Czechoslovakian
English
Ewe
Filipino
French
German
Gujarati
Hindi
Kirundi
Liberyian
Malayalem
Mandarin Chinese
Mano
Mina
Napoli
Nigerian
Oromo
Other
Pular
Punjabi
Spanish
Swahili
Tagalog
Telugu
Urdu
Vietnamese
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
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
Child (Applicant)
First Name (Required)
Last Name (Required)
Suffix
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
White
Hispanic
Yes
No
Other Language
Albanian
American Sign Language
Arabic
Creole
Czechoslovakian
English
Ewe
Filipino
French
German
Gujarati
Hindi
Kirundi
Liberyian
Malayalem
Mandarin Chinese
Mano
Mina
Napoli
Nigerian
Oromo
Other
Pular
Punjabi
Spanish
Swahili
Tagalog
Telugu
Urdu
Vietnamese
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)
Head Start 2023-2024
Early Head Start 2023-2024
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
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
Required information is missing, see above.