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 1st 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 IMPORTANT: If, after you enter your email address, you receive a message indicating that you have previously submitted an application, please contact Community Action Agency, Wendy Ketchens at 517-888-3768 or email This message indicates that you are already in our database and staff need to update your information via phone or email.
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.
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If you have zero income, please enter as $1 dollar.
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.
- Your Address - Available Locations
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Thank you for your interest in Jackson County early childhood programming. By completing and submitting this form you are giving permission for Community Action Agency (Head Start/Early Head Start) or Jackson Intermediate School District (GSRP) to contact you regarding your child's potential eligibility for the Early Head Start, Head Start, and Great Start Readiness Programs. If you appear to be eligible for Head Start or Early Head Start you will receive a call from Community Action Agency to schedule an application appointment. If you appear to be eligible for the Great Start Readiness Program (GSRP) you will receive a phone call to set up an eligibility verification appointment. If you have any questions about this form or experience any problems while completing it, please contact Community Action Agency, Wendy Ketchens at 517-888-3768 or email 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.