Apply Online

Welcome to the Family Forum, Inc. Head Start & Early Head Start Pre-Application. Please complete all fields below. If you need further assistance please call or text the Enrollment Coordinator at 715-919-8658 or email katel@familyforum.org.

Please answer questions about education, employment and income based on the date of the application. For teen parent, only enter 'Yes' if 19 years or younger on the date of application.

First Name (Required)

Middle Name (Required)

Last Name (Required)

Suffix

Birthday (Required)

Gender (Required)

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 (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Best Contact Time

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

Only complete this section if the Secondary Adult is currently living in the home, being supported by the same income and related by blood, marriage or adoption.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name (Required)

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

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 (Required)

Hispanic (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Lives with Family (Required)

Provides Financial Support (Required)

Teen Parent (Required)

Best Contact Time

Are there other adults in the household?

Add Another Adult

For TANF, SSI, WIC or SNAP only answer 'Yes" if you are currently receiving those benefits. Proof of Income and copies of award letters will be requested.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Number in Household (Required)

Number in Family (Required)

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program? (Required)

Is your family receiving Supplemental Security Income (SSI)? (Required)

Is your family receiving services from WIC? (Required)

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? (Required)

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

If your child has an IEP or IFSP in place, please place the diagnosis along with services begin and end dates in the notes section below.

First Name (Required)

Middle Name (Required)

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

Other Language (Required)

Primary Health Coverage (Required)

Other Coverage

Medicaid Eligibility

Doctor/Medical Home

Dental Coverage (Required)

Dentist/Dental Home

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?

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 applying to Family Forum, Inc. Head Start & Early Head Start. A staff member will be contacting you to complete your family's application process. If you would like further information about our program please visit our website or contact your local center. If you have questions regarding your application, call or text our Enrollment Coordinator at 715-919-8658. Find us on Facebook at Family Forum, Inc-Head Start and Early Head Start

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings