We, at Fond du Lac Head Start, are excited you have chosen this program for your child’s preschool learning experience. If you have Tribal Affiliation, you will need to verify this with the Family Service office. **Now is the time to make Health/Dental appointments for your child. Please contact us at 218-878-8100 if you have questions. Thank you.

If pregnant, please type PREG after your name, and document the child’s name (or boy/girl) and due date in child application section. If this child is in Foster Care, please type FC after your name. We will need placement documents and Social Worker information.

First Name (Required)

Middle Name

Last Name (Required)

Nickname

Birthday (Required)

Gender

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

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 (Required)

Hispanic (Required)

Lives with Family

English Proficiency

Other Language

Highest Grade Completed

Employment Status

Child's Relationship (Required)

Custody (Required)

Provides Financial Support

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

Address Line 2

City

State

ZIP

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Nickname

Birthday (Required)

Gender

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

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

Hispanic

Lives with Family

English Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Provides Financial Support

Teen Parent

Number of Parents/Guardians (Required)

Relationship to Participant(s) (Required)

Primary Language at Home (Required)

Is another language being acquired or learned at home? (Required)

Number in Household

Number in Family

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)

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? (Required)

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

Add Emergency Contact

Please document if your child is receiving IEP/IFSP services and the provider, located on the next page after submission.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race (Required)

Hispanic (Required)

Lives with Family (Required)

English Proficiency (Required)

Other Language (Required)

Primary Health Coverage (Required)

Other Coverage

Medicaid Eligibility (Required)

Doctor/Medical Home (Required)

Dental Coverage (Required)

Dentist/Dental Home (Required)

Does your child have a disability or do you have any concerns about your child's development? (Required)

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

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

After you Save and Continue

Please upload all necessary documents in the next window. Once we receive your Pre-application, a Family Service Worker will contact you to schedule an entrance interview. This must be completed before your can be considered for enrollment. Once a spot has been offered to you, a Family Service Worker will contact you to schedule an enrollment interview. This must be completed before your child can start.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings

After you Save and Continue