The Jackson County Preschool Partnership is a collaborative effort involving all publicly funded preschool programs serving Jackson County children. Please take a few moments to complete the form below as the first step in starting your child's journey to school success. Through this process you will be able to indicate interest in starting the application process for Early Head Start (Pregnancy to Age 3 home visit program) or Head Start and Great Start Readiness Program preschool programs with the click of a button. Completion of this interest form or program application 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 and annual income documentation. When asked for your annual income, it is important that you enter an amount or provide an explanation of no income in the comments. Age Eligibility: Your child can apply for Head Start or GSRP preschool if they will turn 4 years old on or before December 1, 2020. If your child will turn age 3 by December 1, 2020 they can apply for Head Start. Early Head Start eligibility allows for pregnant Moms and children under age 3. IMPORTANT: If, after you enter your email address, you receive a message indicating that you have already applied you must contact Community Action Agency at 517-784-4800 and press 4 and then 1 for a Family Engagement Specialist, for assistance as you are in our database from a previous application.
Parent/Guardian
A note about Family Size - please enter all individuals, living in the same household that are related to the enrolling child by blood, marriage or adoption. PLEASE DO NOT ENTER AN INTEREST FORM MORE THAN ONCE. If you have questions, please call Community Action Agency at 784-4800.
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
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.
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
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
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 may be experiencing homelessness.
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 same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
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.
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
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Family Information
If you have zero income, please enter as $1 dollar.
Number of Parents/Guardians
One Parent Family
Two Parent Family
Primary Language at Home
American Sign Language
Asian
Chinese
English
Filipino
French
Indian
Japanese
Punjabi
Spanish
Tamil
Vietnamese
Number in Family
Gross Annual Income
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
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
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
Asian
Chinese
English
Filipino
French
Indian
Japanese
Punjabi
Spanish
Tamil
Vietnamese
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
2020-2021 Jackson Co. Interest
1st Location Preference
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2nd 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 for your interest in Jackson County preschool programs. By completing and submitting this form you are giving permission for us to contact you regarding your child's potential eligibility for the Head Start and Great Start Readiness Programs. The information submitted will be made available to Community Action Agency and the Jackson County Intermediate School District. If you appear to be eligible for Head Start you will receive a call from a Family Engagement Specialist at Community Action Agency to schedule an application appointment. During this appointment you will be able to discuss your needs and find out which program option best fits your family. You will also learn the differences between the Head Start and Great Start Readiness Program. If you appear to be eligible for the Great Start Readiness Program (GSRP) you will need to complete an application by attending an Income Verification Fair. You will be notified of opportunities to apply through a robo-call system. If you have questions you can call the Preschool Hotline Number at 517-768-5130. Please note that you will be asked to provide a birth certificate and proof of annual income at time of application. If you have any questions about this form or experience any problems while completing it, please contact Community Action Agency at 517-784-4800 and press 4 and then 1, 2 or 3 for a Family Engagement Specialist.
Required information is missing, see above.