2024/2025 Head Start/Early Head Start Application for Previous Applicants

2024/2025 Head Start/Early Head Start Application

for Previous Applicants

This form is to be used ONLY by families that have applied for Head Start and/or Early Head Start in

Santa Rosa County District Schools in previous school years (even if your child did not attend the program).

Parent/Guardian Name*

Martial Status*

Select

List name of Children Previous Applied*

Please list the names of all children you have applied for in previous school years.

Physical Address*

Physical Street Address (please provide the address where your family is living, include zip code)

Mailing Address

Mailing Address (if different, include zip code)

Phone Number*

(please list the best number for contacting you by phone)

Phone

Email Address*

(please list the email address you check most often)

HouseHold Annual Gross Income*

What is your household's annual gross income?

List Children Applying For*

List the legal names of all children ages 2-4 you are applying (including their date of birth).

School Choice location

All 2 and 3 year old classrooms are located on the TR Jackson campus located in Milton, Florida.

Please select your first school of choice for the 4 year old children.

Select

By signing this application, I affirm that all the information is correct. I give the Santa Rosa County District School’s Head Start/Early Head Start Program permission to contact me via the phone number and email address I have provided.

Completed Application*

Parent/Guardian Initials

Send me a copy of my responses

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