Head Start Application

Head Start is a comprehensive program for children ages 3 to 5 years old, which encourages social, emotional, intellectual, and physical development. Head Start engages families in the learning process to promote Kindergarten readiness for their child(ren).

Our Head Start centers are located in Kane and DeKalb counties. For more information, please contact your local center or call 1-800-847-9010 and ask for a Family Service Coordinator.

Head Start services include:

• Research-based curriculum
• Field trips and family-child activities
• Nutritious meals and snacks
• Full-day, year-round programs for working parents and/or full-time students at select locations
• Full-day, 10-month programs at select locations
• Transportation for full-day programs at select centers (exceptions may apply)

To be eligible for the Head Start program:

• Your child must be 3 to 5 years old
• Your family should meet federal income guidelines, or meet other eligibility criteria

To apply: Please collect all of the following documents that apply to you, and bring them, with the completed, attached Eligibility Application, to your local Head Start Center or to the Two Rivers Head Start Central Office:

• Completed Eligibility Application (attached)
• Child's certified birth certificate (no copies accepted)
• Copy of most current 1040 tax form, W2 form, or acceptable documentation
• Foster placement letter OR notarized letter confirming guardianship
• SSI eligibility verification letter
• TANF cash assistance verification letter
• Current copy of Medical Card or other medical insurance

Applicant & Family Member Information

"If a family has more than one child applying for services, please complete a seperate copy of this form for each applicant.

Family Information, Income & Contacts

Family Information

Certification: I certify that this information Is true. If any part is false, my participation in this agency's program may be terminated and I may be subject to legal action. I also understand that the information in this application will be held in strict confidence within the agency and Is accessible to me during normal business hours.

Family Information

Work schedule hours:

Two Riven Head Start Agency

Self-Identification of Homelessness

According to the federal McKinney-Vento Homeless Assistance Act, children of families who are currently ·experiencing homelessness arc eligible for Mead Start & Early Head Start. Please have a conversation with your Head Start Family Worker to help determine if your child is eligible by McKinney-Vento standards.

I certify that this information is true. If any part is false, my participation in this agency's programs may 'be terminated and I may be subject to legal action.

Permission Form

Select the options you agree to. Leave the options you do not agree to unselected.

I understand that Two Rivers Head Start Agency will not be responsible for anything that may happen as a result of false information given at the time of enrollment. I have read and understand all of the above. I give my permission where noted.