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Number in Family	Yearly	Monthly	Weekly
2	$21,640	$1,803	$416
3	$27,320	$2,277	$525
4	$33,000	$2,750	$635
5	$38,680	$3,223	$744
6	$44,360	$3,697	$853
7	$50,040	$4,170	$962
8	$55,720	$4,643	$1,072

Number in Family	Yearly	Monthly	Weekly	Under-Enrolled Center Annual Income (Up to 350% Poverty)
2	$43,280	$3,607	$832	$75,740
3	$54,640	$4,553	$1,051	$95,620
4	$66,000	$5,500	$1,269	$115,500
5	$77,360	$6,447	$1,488	$135,380
6	$88,720	$7,393	$1,706	$155,260
7	$100,080	$8,340	$1,925	$175,140
8	$111,440	$9,287	$2,143	$195,020

SECONDARY ADULT:
Click YES if there is another parent/guardian living in the home (including step-parents) or is listed on your child's birth certificate.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

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.

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 (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

White

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Number in Family:
The number of family members in the home: Parents/guardians + dependent children + anyone who is claimed on your taxes (like grandparents or grandchildren)

Gross Annual Income:
Parents' /Guardians' total annual income (what you earn in a year before taxes or expenses are taken out) from all sources including wages, tips, cash income and if applicable, child support, TANF, SSI, school grants, rental income, disability, and unemployment payments

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home? (Required)

Number in Household

Number in Family (Required)

Gross Annual Income (Required)

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? (Required)

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?

The child you are applying to enroll:

Age Requirement for Head Start: Your child must be 4 years old by September 30th or 3 years old by September 30th if you live in the Sterling area.

Age Requirement for the STEP Program: Your child must be 4 years old by September 30th

For income eligibility, please refer to the Income Guidelines above!

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply (Required)

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

White

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage

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

Is there anything else you want to tell us about your child?

Current IEP or IFSP: (Required)

Suspected Disability: (Required)

Emotional Health Concern: (Required)

Chronic Illness: (Required)

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

PLEASE FILL OUT EVERY QUESTION FULLY; BLANKS MAY LEAD TO A DELAY IN PROCESSING.

For more information or for help filling out this application, call the Head Start/STEP Office at (571) 252-2110.
Completing an application for the program does NOT guarantee enrollment.

Required information is missing, see above.

Head Start Offers:

Program Requirements:

STEP Program Offers:

Program Requirements:

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings