Pre-Application Questionnaire/Cuestionario Inicial
This is the First Step to Apply for Head Start or Early Head Start / Este es el primer paso para aplicar para Head Start o Early Head Start
Child's First Name (Nombre del Nino) *
Your answer
Child's Last Name (Apellido del Nino) *
Your answer
Child's Date of Birth (Fecha de Nacimiento del Nino) *
Your answer
Parent/Guardian's First Name *
Your answer
Parent/Guardian's Last Name *
Your answer
Contact Numbers (Numeros de Telefono) *
Your answer
Mailing Address (Direccion del Correo) *
Your answer
Email Address
Your answer
Can we contact you using a text message?
(We use google voice for this)
Primary Contact Language * *
(Idioma Primario de Contacto)
Is there anything we should know about contacting your family? / Hay algo que debemos saber a cerca de como contactar a su familia?
For example: Only call between certain times or on certain days, live at different address than mailing address, etc. / por el emplo: solo llamar entre ciertas horas, o ciertos dias, viven en direccion diferente del codigo postal
Your answer
Head Start Staff member will contact you about setting up an interview.
Submit
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