Head Start Pre-Registration Application

This pre-registration application is meant to determine possible eligibility for Head Start and Early Head Start programs. If it looks like your child will qualify for Head Start, you will be contacted by a nearby agency with additional information.

Parent / Guardian Information

Used only for contacting qualifying applicants. Is there another number to reach you by? In the format 'mm/dd/yyyy'
Enter your address. Enter your city. Enter your state. Enter your zip code.

Child's Information

In the format 'mm/dd/yyyy'

What qualifies as a disability?

For a general definition about what qualifies as a disability, visit this link. If you feel your child may qualify but are unsure, select "Yes". Exact qualification status can be determined later.

Family Information

What is a parent type?

Parent type describes the relationship of the parent(s) and child. Note that the parent does not have to be a biological relative to qualify as a parent figure.

What is SSI?

Supplemental Security Income (SSI) pays monthly benefits to people and children with limited income and resources who are disabled, blind, or age 65 or older. To read more about SSI, click here.

What is TANF?

The Temporary Assistance for Needy Families (TANF) program is designed to help needy families achieve self-sufficiency. States receive block grants to design and operate programs that accomplish one of the purposes of the TANF program. To read more about TANF, click here.

The name of the facility applied too, if you have already applied. Leave this blank or select "have not applied" if you did not fill out the previous field.