Head Start Pre-Application 2022 - 2023

Pre-Application

Children must be 3 or 4 years old by August 31st of the current year. 

Program Year: 2022 - 2023
Today's Date: 

 

 

Child's Name:  Date of Birth:  
Parent Name: 
Living Address:  City:  State:  Zip Code: 
Mailing Address: 
Home Phone:  Cell Phone: 
Alternate Contact Name: 
Alternate Telephone Number: 
Email: ​
Comments: 

 

 

 

 

 

 

 

 

 

 

 

 



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