Step 1: Child Information



Step 2: Household Information

Step 3: Emergency Contact Information



I have carefully reviewed the information in this form and by electronically signing this application, certifies to the best of my knowledge and belief that all information in this application is true and correct. I further understand that this is and an application for services that are paid with federal funds and that intentionally providing misleading, inaccurate or untruthful information of a material nature could result in dis-enrolling my child from Head Start/Early Head Start and is considered fraud and could have serious legal consequences for me. 

Step 4: Application Cover Sheet

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