Thank you for your interest in Head Start. Please fill out the information below and click send. We will get back to you within 5 days.
Parent/Guardian
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Prefer to Self Describe
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
Bulgarian
Chinese
English
Patois Jamaica
Portuguese
Spanish
Thai
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
Custody
Yes
No
Teen Parent
Yes
No
Address
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
Click here
to find a provider in your area.
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
Prefer to Self Describe
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
Bulgarian
Chinese
English
Patois Jamaica
Portuguese
Spanish
Thai
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
Custody
Yes
No
Lives with Family
Yes
No
Teen Parent
Yes
No
Family Information
Please tell us about your family.
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
Bulgarian
Chinese
English
Patois Jamaica
Portuguese
Spanish
Thai
Is another language being acquired or learned at home?
Yes
No
Number in Household
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)
Please tell us about your child.
First Name (Required)
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Prefer to Self Describe
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
Bulgarian
Chinese
English
Patois Jamaica
Portuguese
Spanish
Thai
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
Other Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Insurance Number
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Medicaid Number
Doctor/Medical Home
Abundant Life Nutrition
Andrea Stumpf Reams, AuD CCC-A
Bramblebush Pediatrics
Cambridge Health Alliance
Cape Cod Hospital
Cynthia Esteban, CNP
Dartmouth Health Childrens
Dr Amar Luzic
Dr Caldwell
Dr Judy Jones
Dr Melanie Miller
Dr. Edward Caldwell
Dr. Ellen McMahon
Dr. Hawes
Dr. Julia Stunkel
Dr. Scott Simmons
Dr. Sonya Stevens
Dr. Steven Feder
Dr. Virkud
George Santos
George Santos
Giannina Tierney
Gifford Medical Center
Henry Neider
Island Health Care
Julia Singleton
Karen Williams
Laura Denman
Lesley Segal
Martha's Vineyard Hospital
Mass Eye and Ear
Mass General
Ryan Shea
Seaside Pediatrics
Spaulding Rehab Hospital
Stacia Broderick
Vineyard Pediatrics
Dental Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Dental Coverage Number
Dentist/Dental Home
Boston Children's Hospital
Bourne Dental
Bourne Dental
Cape Cod Community Health Dental
Centerville Dental
CMOS
Dr. Ashley Soliman
Dr. Golden
Dr. Guck
Dr. Robert Hermann
Dr. Seth Latimer
Dr. Swain
Dr. Swann
Falmouth Dental Associates
Family Dental Resources
Franciscan Hospital
Helayne Schaeffer
Kid Smiles
Martha's Vineyard Hospital
Mashpee Dental Associates
New Bedford Dental Associates
Pocasset Family Dental
Polished
Scituate Oral Surgery
Vineyard Haven Dental
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Head Start 2024-2025
Home Visitation Program for Children 3-5
Early Head Start 2024-2025
Home Visiting Program for Children 0-3
Location Preference
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1st Location Preference
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2nd Location Preference
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3rd 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 again for your interest in the Head Start programs. Please click send to submit your application. When it is received, you will receive a confirmation from us. Within five days, someone will be in touch with you to set up a recruitment visit.
Required information is missing, see above.