Family Development Services
 
 

Please complete this form to begin the Head Start application process. All fields marked with an * are required. If you have questions, look at our FAQ, or contact us.

Pre-Enrollment Form

Program





Program Preference

*Early Head Start: M-F 8:30am -4:30pm

Parents must be working or in school to apply
We will keep your application on file until May 2021 and we will contact you if we have an opening at the center of your choice.

Applicant Child:













































Primary Adult:


























*Check all that apply for this adult

Lives with FamilyProvides Financial SupportTeen Parent




Secondary Adult:


























*Check all that apply for this adult

Lives with FamilyProvides Financial SupportTeen Parent




Family Information





















Primary Adult



































Second Adult



































Other Non-Applicant Children in Family



















































Please answer the following questions:








Parent/Guardian Consent

*I certify that all information provided on this application is accurate to the best of my knowledge.





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