Apply Online

Welcome to NACOG Head Start/Early Head Start on-line application! You and your child are very important, and we want to make your application process as simple as possible. If you experience any issues with the application process, please call (928) 774-9504, ext. 1112 or email nacoghs@nacog.org. If you applied in person at one of the sites, you do not need to submit an application online. Our Vision: "Inspiring Tomorrow’s Future Today" Our Mission: "Inspiring Change Through Opportunity"

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

Opt In for Text Messages

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

Hispanic

Highest Grade Completed

Employment Status

Child's Relationship

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.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Mobile Phone

Opt In for Text Messages

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

Hispanic

Highest Grade Completed

Employment Status

Child's Relationship

Are there other adults in the household?

Add Another Adult

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Family

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)

Nickname

Birthday (Required)

Gender

Race

Hispanic

Does your child have a disability or do you have any concerns about your child's development?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd 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

Thank you for your interest in NACOG Head Start and Early Head Start. Please click “SUBMIT” to finalize your application. A Head Start staff member will contact you within 5 business days to schedule an eligibility interview and share the next steps. You will need to provide proof of income, proof of child’s age, and child’s current immunizations. If you are having difficulty submitting this form, please call (928) 774-9504, ext. 1112. Thank you for your time!

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings