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EOP Birth to 5 School Readiness LOGO. Headstart and Early Headstart

Birth to Five
School Readiness Program
Head Start / Early Head Start

Pre-Enrollment Application Form

If you are interested in enrolling your child, please fill out and submit the form below or download and submit a full printable application here: 

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Once submitted, an Enrollment Specialist will reach out to you with next steps in completing your child’s application.

  • Please gather the following supporting documentation: proof of income and address, your child's birth certificate and updated Physical and Immunization records, and medical insurance card.

Start EOP Head Start/Early Head Start Enrollment Form
I would like to apply for:

Please Provide CHILD information

CHILD's Gender

Please provide Parent/Guardian (PG) current address & other contact details

Employment Status
Relatonship to Child

Family and Housing Information

Other income my family receives
Family Type
My family is temporarily living with a friend or family member because we cannot find affordable housing
Have you applied to the B25 School Readiness program or another EOP program before?
My family is living in emergency/transitional housing
My family is living in a motel/hotel, street, camp ground, or vehicle
I am interested in the following locations
How did you hear about the Birth to Five School Readiness Program?
Does your family have reliable transportation?
Does your CHILD receive these services

Congratulations on taking the first step towards your child’s early education!
 

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