Welcome to the Head Start Family and our new 2023-2024 school year. We are happy that you chose the Head Start Program as a safe and comprehensive learning environment for your child and family. To help you and your family understand what we need to successfully subscribe your child to our program please take a look at the checklist that our directors and staff use to qualify you and your child. Head Start Application Checklist 2023-2024 (In order)

1. Income Verification Form (On site)
2. Proof of Income (Bring any one of three listed below)
   • Three consecutive paystubs (going back from the date of the interview)
   • W-2 (Wage and Tax statement)
   • Letter from employer with third party consent & employment verification form
3. ​Eligibility Verification form (On site)
4. ​Proof of Address (Bring a recent utility bill under parent/guardian name, posted mail, or a current non-expired lease agreement)
5. ​Family Information, Income & Contacts Form (On site)
6. ​Applicant & Family Information Form (On site)
7. ​Applicant Eligibility & Enrollment Information Form (On site)
8. ​Child’s Birth Certificate (Bring an original or certified copy)
9. ​Child’s Immunizations (Bring the original doctor or clinic record)
10. ​Physical Exam (Including PPD, Lead, Sickle Cell, Vision and Hearing)
    • Download the Child Health Record Form 3 Screenings and Physical Exam here (PDF – 179kb)
11. Dental Exam
12. Individualized Education Program (IEP) – if applicable
13. Child Insurance Card (or letter showing parents applied for insurance, a New York State Benefit Identification card is NOT accepted as a Child Insurance card)
14. Parent Identification (Bring a photo ID)
15. Statement of Needs (On site – fill out in full)

​(ALL forms that require parent or family service worker signatures MUST be signed before the application can be accepted by the Corporate Office. All forms are available “On site” at your local Head Start Center)