Head Start/Early Head Start Recruitment Form


If you are interested in your child attending Head Start or Early Head Start, please fill out this form and submit. A Head Start or Early Head Start coordinator will contact you within a few days to discuss your information and set up a home visit.

Do you live in Clinton County or Franklin County? *
Parent/Guardian *
Home Phone *
Home Phone
Work Phone
Work Phone
Address *
Child's Name *
Child's Name
Social Services Received
Does anyone in the household receive SSI? *