Head Start/EHS Application - English
****IMPORTANT**** Once you fill out the application you will need to submit the following documents: 12 months income (paystubs or tax documents), your child's birth certificate, immunization records, your child's medical insurance card (if applicable), and a recent Well Child Exam or Dental Exam if applicable. For Head Start please submit your documents to Sylvia Wilson at sylvia.wilson@regionix.org. For Early Head Start please submit your documents to Dana Jensen at dana.jensen@regionix.org. You can also bring your documents by our main office at Sierra Vista Primary or at Mountain Annies. Thank you!
Sign in to Google to save your progress. Learn more
Which Site Are You Applying For? *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Region IX Education Cooperative. Report Abuse