Head Start Application

Please complete the form below. We will contact you in order to schedule an intake appointment.

Applicant Information
For more information please contact us at 609-695-6274 x213

***This Application is for Mercer County, New Jersey Residents Only
Please indicate if applicant is:*
- Child
- Pregnant/Mother
Number of Members in the Household
Is your child currently enrolled in a Pre-K program
- Yes
- No
Has your child ever been enrolled in a Head Start program
- Yes
- No
If yes, what is the name of the program?
Do you have a preferred site location? Please note first and second choice
Applicant Name*
Expected Delivery Date
Parent's Name (if applicant is a minor)
Applicant Birth Date*
MM
DD
YYYY
Address*
City*
ZIP*
Primary Phone*
Secondary Phone
Email
Enter Email Confirm Email
Primary Language
- English
- Spanish
- Other
Input your primary language here.
How did you hear about us?
Name of Person/Organization That Referred You
Uploading Important Documents
ALL FORMS REQUIRED**
Please attach the following documents for Head Start and Abbott • Rent Lease Agreement • 2 Utility bills • A Letter from the Department of Social Services • Income for both parents • Child’s birth certificate • Immunization records • Physicals
Rent Lease Agreement
2 Utility bills
A Letter from the Department of Social
Income for both parents
Child’s birth certificate
Immunization records
Physicals

Applicant Information