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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