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Submit an Application

Complete and submit the enrollment application. Required fields must be filled in. After your application is processed, a program representative will contact you.

Questions may be sent to [email protected].

Application Information

The application requests:

• Child’s name and date of birth
• County and requested program year
• Family size and approximate annual income
• Parents’ or guardians’ names and guardian status
• Home address, telephone number, and email address
• Disability information for the child or parent
• Participation in school, Families First, or Even Start
• Childcare certificate status
• Whether the child or a sibling previously attended Head Start