Update my Early Head Start /Head Start Application
Thank you for your interest in our program. This application is for families who have previously applied for services and wish to update their child's application. If this is your first time applying, please go back to the RUCD website (
) and submit a new application.
Information collected during the application process will be kept confidential. If you need assistance applying, please call (800) 841-2867 ext 123. Questions marked with an asterisk (*) are required and must be completed before moving to the next section.
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Child's Date of Birth
Your First & Last Name
What is your relationship to the applying child?
Your Date of Birth
Physical Address (Street)
City, State, Zip
Mailing Address (if different from above)
What is the best way to contact you?
What is the best time to contact you?
What is the primary language spoken in your home?
If English is not your primary language, we will provide an interpreter if requested. Interpreters must be at least 18 years of age. Would you like us to schedule an interpreter for Head Start related appointments, activities, and events throughout the year?
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This form was created inside of Rural Utah Child Development Headstart.