Parent/Guardian
First Name (Required)
Middle Name
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
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.
Teen Parent
Yes
No
Address
Please enter the address where you currently reside.
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Location Preferences
Which program are you applying for? (Required)
Head Start for Children Age 3 and 4.
Free Servcies for Children Age 3 and Age 4.
Early Head Start I Services Children 0 - 35 mths
Free Services for Children 6 weeks - 35 months
Early Head Start-CCP Services Children 0 - 35 mths
Free and CCS for Children 6 weeks - 35 months
Early Head Start II Services Children 0 - 35 mths
Free Services for Children 6 weeks - 35 months
Head Start for Children Age 3 and 4.
Free Servcies for Children Age 3 and Age 4.
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
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to find a provider in your area.
Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Required information is missing, see above.