Apply Online

Please complete all fields.

If you already have a child enrolled in our program and wish to enroll a sibling, or your child has been previously enrolled in our program, please call 970-828-5906 to schedule an enrollment appointment. You will not be able to apply through this page.

Purposely withholding or providing false information may result in the temporary exclusion of your child while proper accommodations are made. Tri-County Head Start does not discriminate against any person on the basis of race, religion, color, national origin, disability, sexuality, or age in admission, treatment or participation in its programs, services or activities. This information is used for classroom planning and to allow Tri-County Head Start to provide accommodations for the health and safety of your child. All information provided is confidential and not shared with third parties without parental consent.

Please complete this section with the information for the primary adult contact for the child. All questions must be answered for the application to be considered complete.

First Name (Required)

Middle Name

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

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

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Lives with Family

Provides Financial Support

Please complete with current address information. If you do not have a living address, please leave it blank.

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

Please complete this section if there is a secondary adult contact for the child. All questions must be answered for application to be considered complete.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

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)

English Proficiency (Required)

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Lives with Family

Provides Financial Support

Are there other adults in the household?

Add Another Adult

Please fill out this section as completely as you can. Any income-based information will need to be verified by relevant documentation such as a W2, pay stubs, or award letters. All questions must be answered for the application to be considered complete.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home?

Number in Family

Gross Annual Income

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)

Please complete this a section only for the child you are wishing to enroll. All questions must be answered for application to be considered complete.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race (Required)

Hispanic (Required)

English Proficiency (Required)

Other Language

Other Language Proficiency

Primary Health Coverage

Doctor/Medical Home

Dentist/Dental Home

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

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 your interest in Tri-County Head Start. A member of our enrollment staff will contact you to schedule an enrollment appointment to complete your application.

*Please note that your application will not be considered complete, and your child will not be added to the wait list, until you have completed an enrollment appointment and all required documents have been submitted.

Required information is missing, see above.

Please complete all fields.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings

Thank you for your interest in Tri-County Head Start. A member of our enrollment staff will contact you to schedule an enrollment appointment to complete your application.

*Please note that your application will not be considered complete, and your child will not be added to the wait list, until you have completed an enrollment appointment and all required documents have been submitted.