Apply Online

Thank you for your interest in Orange County Head Start/Early Head Start. Please complete this application to the best of your knowledge. Once submitted, you should send us documentation to prove age of your child, your residency (utility bill on your name or lease agreement) and Proof of income for the last 12 months for your family. Call 919-490-5577 ext 248 for additional questions or if you anticipate having difficulty getting these documents. We can help!

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

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

Home Phone

Work Phone

Ext.

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Provides Financial Support

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.

If your child's other parent lives with you and your child, please provide his/her information bellow

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

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

Home Phone

Work Phone

Ext.

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Primary Language at Home

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?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

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

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

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

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Hispanic

English Proficiency

Other Language

Primary Health Coverage

Which program are you applying for? (Required)

1st Location Preference

2nd 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

Click submit to send your application. Please call us at 919-490-5577 ext 248 to schedule an appointment to meet with us. You can bring documentation of age of your child, residency and income to your appointment. Our offices are located in Chapel Hill (800 Eastowne Dr., Suite 105, Chapel Hill NC 27514 ) and Hillsborough (125 Lawndale Avenue, Hillsborough NC 27278)

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings