The following is an INTEREST form for Long Island Head Start. The Head Start Program is for Pre-School children ages 3 to 5 - Please complete if your child will be 3 years old before December 1st. The Early Head Start Program is for children birth to 3 and an Expectant Mother Program is also available. The Early Head Start - Child Care Partnership Program is for children 6 weeks to 3 years old. After completing, a Family Advocate, Family Educator or Family Service Worker will contact you depending on the appropriate program you applied for. In order to fully process your application we would need you to kindly provide: Child's Birth Certificate, Child's Health Insurance Card, Parent Photo ID, Child's Immunization Record, and Proof of Family Income (2-3 recent pay stubs; 1040; W2; or Employer Letters - for both parents if 2 parent family).
Please fill out information about the child's parent or legal guardian.
Click here to find a provider in your area.
Please complete if you have a second parent or guardian living in the household.
Please fill out information about your child. Please enter name exactly as shown on the birth certificate.
- Your Address - Available Locations
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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 Long Island Head Start! We look forward to meeting with you!
Required information is missing, see above.