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Gila River Head Start/ Early Head Start Pre-Application
Thank you for your interest in the Gila River Head Start Program. Please fill out this Pre-Application form completely and the corresponding GRIC Head Start Location will be in touch.
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Which Head Start Location are you interested in?
*
Sacaton Head Start - District 3 (112 W. Seed Farm Rd. Sacaton, Az 85147)
Santan Head Start- District 4 (1447 Santan Rd. Sacaton, Az 85147)
Vah-Ki Head Start- District 5 (3441 W. Casa Blanca Rd. Casa Blanca, AZ 85121)
Komatke Head Start -District 6(16675 S. Saint Johns Rd. Laveen, AZ 85339)
Early Education Child Care - District 3 (280 S. Ocotillo St. Sacaton, AZ 85147)
Child's Name
*
Your answer
Gender
*
Male
Female
Child's Birthdate
*
MM
/
DD
/
YYYY
Parent/ Guardian's Name
*
Your answer
Relationship to Child
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Parents
Mother
Father
Aunt / Uncle
Grandparent
Guardian
Phone Number- Home
*
Your answer
Phone Number- Cell
*
Your answer
Are you able to receive text messages?
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Yes
No
Other:
Email
*
Your answer
Mailing Address
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Your answer
Physical Address
*
Your answer
Do you reside within the Gila River Indian Community?
*
District 1
District 2
District 3
District 4
District 5
District 6
District 7
Surrounding City
Other:
Required
Any questions, comments, or concerns?
Your answer
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