Please fill in all the fields listed below to enroll in Early Head Start or Head Start in Marshall County or Starke County in Indiana.
Parent/Guardian
Please enter your phone number on this page, so we can contact you to complete the application.
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)
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 and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Prefer not to answer
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
English
Other
Romanian
Sign Language
Spanish
Spanish
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.
Additional Parent/Guardian
Only complete this section if the Secondary Adult is currently living in the home and related by blood, marriage, or adoption.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Family Information
"Participant" is defined as the child you wish to enroll. "Family" is defined as all persons living in the same household who are supported by the income of the parent(s) or guardian(s) of the child enrolling. If you have no income, please indicate "0" in the gross annual income box.
Primary Language at Home
American Sign Language
Arabic
English
Other
Romanian
Sign Language
Spanish
Spanish
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?
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 (Required)
Female
Male
Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African
Native Hawaiian or Pacific Islander
White
Prefer not to answer
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
English
Other
Romanian
Sign Language
Spanish
Spanish
Location Preferences
Which program are you applying for? (Required)
Head Start Preschool
Free for children ages 3 to 5
Early Head Start 25-26
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
Thank you for your interest in our Head Start / Early Head Start program. Please click submit to finalize your application. We will contact you to set up an intake appointment. If you have any questions call Rae at 574-936-7885.
Required information is missing, see above.