Welcome! We are excited you have decided to apply for your child! Please make sure that you fill out the application completely. You will be asked to submit your child's birth record & income information for your household for the past 12 months. If you have questions, or need help gathering this documentation, please feel free to contact our office at 652-3229, Monday - Friday, from 8 am until 4 pm.
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Chinese
English
Hmong
Korean
Russian
Spanish
Spanish - Other Dialect
Ukranian
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
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to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
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.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Chinese
English
Hmong
Korean
Russian
Spanish
Spanish - Other Dialect
Ukranian
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
American Sign Language
Chinese
English
Hmong
Korean
Russian
Spanish
Spanish - Other Dialect
Ukranian
Vietnamese
Is another language being acquired or learned at home?
Yes
No
Number in Family
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Chinese
English
Hmong
Korean
Russian
Spanish
Spanish - Other Dialect
Ukranian
Vietnamese
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Doctor/Medical Home
ABC Pediatric Asheville
Amy Ende
Anderson Medical Park
Asheville Children's
Asheville Eye
Asheville Pediatric Associates
Blue Ridge Pediatrics Newland NC
Blue Sky Pediatrics Asheville
Burke Primary care
Carolina Ear, Nose and Throat
Carolina's Healthcaresystem
Catawba Pediatric Associates PA
Catawba Valley Med. Graystone
Childrens Dev. Services Agencies
courtney gardner
Dr. Jim Robinson
Exceptional Children's Program
Invitation Therapy
MAHEC
Marion Pediatrics and Adolescent
McDowell County Health Dept.
McDowell Family Medicine
McDowell Family Practice
Mcdowell Hospital
McDowell Medical Associates-Nebo
McDowell Pediatrics
Mission Children's Olson Huff
Mission Children's Specialist
Mission Family Medicine
Mission Health Center
Mission Pediatrics
Mission Pedictrics
Mission Women's Health
Mountain Area Peds- Asheville
Mountain View Pediatrics
Myers Park Pediatrics
Old Fort Community Medicine
Olson Huff Center
Piedmont Pediatrics
Play Again Therapy
Professional Vision Center
Rutherford Pediatric
Shelby Children's Clinic
Table Rock Family Medicine
WNCCHS McDowell Health Center
Dentist/Dental Home
Asheville Pediatric Dentistry
Best Bites
Blue Ridge Pediatric Dentistry
Dr. Gary Hensley
Dr. Grindstaff
Dr. Hunt/Forest City
Great Beginings
Growing Smiles
High Country Com. Health Dental
Marion Dental Group
Marion Family Dental
Mecklenburg Pediatric Dental Cli
Michael K. Wimberly PC
Mitchell & Mitchell DMD
Mitchell Family Dental
Morganton Childrens Dental
Rutherford County Denistry
Scott Murphy Family Denistry
Smile Starters
Southern Family Denistry
Thome & Hendrick DDS PLLCC
WNCCHS McDowell Health Center
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Head Start 2022 - 2023
Early Head Start 2022 - 2023
1st Location Preference
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2nd Location Preference
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- Your Address
- Available Locations
Click a location on the map to see more info
Click here
to find a provider in your area.
Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Siblings
Are there other children in the family?
Add a Sibling
Thank you for completing our application! You will receive an email confirmation shortly.
Required information is missing, see above.