Headstart Enrollment

If you are interested in enrolling your child, please fill out the form below or download a printable application.  A staff member will contact you as soon as possible with more information. 

You may also stop at the center nearest you at any time.  You will need to bring the following information in with you: proof of income, your child's birth certificate, shot record, and medical insurance. Physical and dental exam forms are available here to be printed or these forms can be given to you at any center.  These forms must be completed before the child can attend our program.

EOP Head Start Enrollment Form

Child Information

Foster Child
Does child have an IEP?

Parent Information

Married or Single?
Currently Pregnant?
School Status
Type of Income
Work Status
Do you receive:
House or Apartment?
Own or Rent?

Please list all additional people living in your household

Has anyone in the household previously attended Head Start or Early Head Start?

Thanks for applying to Headstart!
We'll get back to you soon.