For your convenience, you can print off this application. Please fill it out and bring it into the office. Do not fill out the shaded portion. You will need to bring the application in with your child's birth certificate, shot record and medicaid card, your income verification and social security cards for all the members in your family. Please call if you have any questions. (910) 487-9800

Head Start Application - English

Head Start Application - en Español
This application is a product of ChildPlus Software.

Once the parent has been contacted for enrollment, the below listed forms will need to be completed and returned to our office as well.

Physical Examination
Child Dental Health Record