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TRI-COUNTY HEAD START/EARLY HEAD START

Days of the Week in Care: Monday-Friday
Primary Hours of Care: 8:00am-2:00pm
Meals Served While in Care: Breakfast, Lunch, PM Snack

This is a pre-application only, you will be contacted by the Family Service Advocate to set up an appointment to complete the remainder of the application.

Early Head Start accepts children 6 weeks-3 years old.
Head Start accepts children who are 3 years old by 9/1 until they are 5.

If you are interested in applying for your child, please fill out the application completely and to the best of your knowledge, any falsified information could lead families/children being dropped from the program. Please have the following items ready to upload for verification purposes: Birth Certificate/Medicaid card (must be legible to read name and date of birth) SNAP/TANF/SSI Benefits *If you do not receive any public assistance; W-2 or 1040/1040A tax return can be submitted* IEP or IFSP Documentation (if applicable) Foster/Kinship Care Documentation (if applicable) Delaying submission of these documents could hinder the processing time.

IF YOU CURRENTLY HAVE A CHILD ENROLLED OR HAD A CHILD PREVIOUSLY ENROLLED, PLEASE USE THE LINK BELOW INSTEAD.

LINK: Returning/Prior Family Application

This portion of the application is for the parent who will be the main point of contact for the child who is applying. Please provide as much information as you are able.

First Name (Required)

Last Name (Required)

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 (Required)

Home Phone (Required)

Work Phone (Required)

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

Native Hawaiian or Pacific Islander

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)

If Teen Parent, Subsidized? (Required)

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

Secondary adult will be contacted if the primary adult is not able to be contacted.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

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 (Required)

Home Phone (Required)

Work Phone (Required)

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

Native Hawaiian or Pacific Islander

White

Lives with Family (Required)

English Proficiency (Required)

Other Language

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody (Required)

Provides Financial Support (Required)

Teen Parent (Required)

If Teen Parent, Subsidized? (Required)

Are there other adults in the household?

Add Another Adult

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 (Required)

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? (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)

Add Emergency Contact

First Name (Required)

Middle Name

Last Name (Required)

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

Native Hawaiian or Pacific Islander

White

Lives with Family (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Medicaid Eligibility (Required)

Doctor/Medical Home

Dental Coverage (Required)

Dentist/Dental Home

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

Hospital Preference: (Required)

Allergies/Medical Needs (Required)

Child's Emergency Plan:

Disability Concerns (Required)

Family Trauma (Required)

High Risk Pregnancy (Required)

State Involvement (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

Submitting this application indicates that the information on this enrollment/application form is complete and accurate. I hereby grant permission for the staff of this facility to have access to my child’s records. Thank you for you interest in our Head Start Program. Click submit to finalize your pre-application. A confirmation email will be sent to you.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings