Please indicate interest in Early Head Start (Pregnancy to Age 3 home visit program) or Head Start (Ages 3-4) and Great Start Readiness Program (Age 4) preschool program. Children must be age 3/4 on or before December 1 of the school year to be eligible for preschool. Completion of this interest form does not guarantee your child will be served by a publicly funded preschool program. As part of the application process you will need to provide: • Proof of birth • Annual income/eligibility documentation Completion of this interest form or program application does not guarantee your child will be served by a publicly funded preschool program. IMPORTANT: If, after you enter your email address, you receive a message indicating that you have already applied you must contact Community Action Agency. Please contact Nadia Salameh at 517-257-9287 or email nsalameh@caajlh.org.

Parent/Guardian

Please note that some fields are required.

Address

Who is considered homeless? Under the McKinney Vento Act, the term "homeless children and youths" means individuals who lack a fixed, regular and adequate nighttime residence and includes children and youths: (1) who are sharing the housing of others due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or are abandoned in hospitals; (2) who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings; (3) who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings; and (4) who are migratory children who live in one of the above circumstances. If you find yourself in one of these situations, please indicate below that you are experiencing homelessness.
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Additional Parent/Guardian

Family Information

Child (Applicant)

If your child has an IEP (Individualized Education Plan) or IFSP (Individualized Family Service Plan) please select "yes" for the question "Does your child have a disability?" In the note area, please provide information about your child's specific needs. If you are a pregnant mother applying for Early Head Start, please enter parents information for First Name, Last Name, and Date of Birth.

Location Preferences
- Your Address - Available Locations
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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 your interest in Hillsdale County Early Childhood programming. By completing and submitting this form you are giving permission for us to contact you regarding your child's potential eligibility for the Early Head Start, Head Start and Great Start Readiness Program preschool. Community Action Agency and the Hillsdale County Intermediate School District will have access to the information you submit. You will receive a call from the Appointment Scheduler at Community Action Agency to schedule an application appointment for Head Start or Early Head Start. During this appointment you will be able to discuss your needs and select the location(s) you wish your child to be waitlisted for. You will also learn the differences between the Head Start program and Great Start Readiness Program. Head Start is a federally funded program and can offer additional supports that may be of help to your child and family. While speaking with the Family Engagement Specialist, you can decide if you would prefer not to attend Head Start (if you are income eligible). If you choose to enroll in the state funded Great Start Readiness Program, you agree to waive Head Start services by submitting this form. Those interested in applying for Great Start Readiness Program for four year olds will be contacted by HCISD. For questions, please call 517-689-1842. If you have any questions about this form or experience any problems while completing it, please contact Community Action Agency at 517-437-3346, press 3246 for assistance. You can also contact Nadia Salameh at 517-257-9287 or email nsalameh@caajlh.org. Parent Certification Statement: I certify that this information is true. If any part is false, my participation in this agency's programs may be terminated and I may be subject to legal action.
Required information is missing, see above.