HS/EHS Online Application

Please complete the application below and upload pictures of the following items listed below.

Head Start is a free preschool experience for income eligible families. In order for a Head Start application to be completed and processed and the child put on a waiting list, income verification is needed showing 12 months of income for parents listed in the household. Below are different ways that income can be verified. A picture of any of the documents can be uploaded at the end of this application.

For questions and more information regarding Head Start applications, please email Stacy at sking@hacap.org or by calling us at (319) 393-7811 and press 4 to speak with one of our staff members during our regular business hours Mon-Fri 8:00am -5:00pm.  

Housing: *
Family Type: *
List all household members below including yourself:
Primary Adult Income Sources: *
Secondary Adult Income Sources:
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 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.
Head Start/EHS Application Cover Sheet
Family Need:
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