Apply Online

Welcome to the Alexander County Head Start Online Application! Please fill out all the fields below. If something doesn’t apply to you or your family, just put N/A. If you have any questions about the application, feel free to contact Mackenzie Pritchard, the ERSEA Coordinator, at (704) 585-6390. *Important: We would like to inform you that our services are exclusively for residents of Alexander County. If you do not reside in Alexander County, please visit the Head Start program locator at: https://headstart.gov/center-locator/embedded?redirect=eclkcor or you can contact us for further assistance.

Please answer the questions below to provide us with some general information about your household. This information will assist us in determining your family's eligibility. The more details you can share, the smoother the processing of your information will be. Please answer the questions to the best of your knowledge. If a question is not relevant to your family, please type or select N/A to indicate that it wasn’t overlooked. Thank you!

First Name (Required)

Middle Name

Last Name (Required)

Birthday (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)

Opt In for Text Messages

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.

Lives with Family (Required)

English Proficiency (Required)

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Provides Financial Support (Required)

Teen Parent

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 (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Please enter the secondary adult living in the home if applicable. Please type N/A if not applicable.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Mobile Phone (Required)

Opt In for Text Messages

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.

Lives with Family (Required)

English Proficiency (Required)

Highest Grade Completed (Required)

Employment Status (Required)

Child's Relationship (Required)

Custody

Provides Financial Support (Required)

Teen Parent

Are there other adults in the household?

Add Another Adult

The following information will provide Alexander County Head Start with important information to assist in determining your child's eligibility into the program.

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Number in Household (Required)

Number in Family (Required)

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)

WIC ID (if applicable)

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?

Is at least one parent/guardian a veteran of the United States military?

Add Emergency Contact

Please tell us about the child you are applying for. Providing detailed information will help us to determine the services that we can offer once your child's eligibility is determined and the child is accepted into the program.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Lives with Family (Required)

English Proficiency

Primary Health Coverage (Required)

Other Coverage

Insurance Number

Medicaid Eligibility (Required)

Medicaid Number

Doctor/Medical Home (Required)

Dental Coverage (Required)

Dental Coverage Number

Dentist/Dental Home (Required)

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

How did you hear about us (Required)

If Other, please explain: (Required)

Alexander Co. Resident? (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

Thank you for your interest in Alexander County Head Start. As part of the application process, we will contact you to arrange a meeting, collect any remaining documents or information, and finalize your application for processing. We are eager to meet with you to complete this process. Someone will be in touch soon to schedule an appointment, so please ensure that your email and phone number are accurate for our staff to contact you. If you wish to check the status of your application at any time, feel free to reach out to our ERSEA Coordinator, Mackenzie Pritchard, at 704-585-6390.

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