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PACE Application

Thank you for your interest in Pace Head Start. This application is for new students only. Head Start does not operate on a first come, first served basis; children are awarded points and the children with the highest points are enrolled first. Once you've completed the application a staff member will contact you. If you have not heard from our staff within 7 days please feel free to call us.

Parent / Guardian

First Name *:
Last Name *:
Birthday *:
Gender:
Email Address:
Confirm Email Address:
Mobile Phone:
Opt In for Text Messages:
Home Phone:
Work Phone:
Child's Relationship:

Address

Is your family experiencing homelessness?:
Living Address *:
Address Line 2:
City *:
State *:
ZIP *:

Family Information

Number of Parents/Guardians:
Relationship to Participant(s):
Primary Language at Home:
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?:
Is your family receiving Supplemental Security Income (SSI)?:

Child Applicant One

First Name *:
Last Name *:
Nickname:
Birthday *:
Gender:
Race:
Hispanic:
Does your child have a disability or do you have any concerns about your child's development?:
Is there anything else you want to tell us about your child?:

Child Applicant Two
First Name *:
Last Name *:
Nickname:
Birthday *:
Gender:
Race:
Hispanic:
Does your child have a disability or do you have any concerns about your child's development?:
Is there anything else you want to tell us about your child?:

Location Preferences for Child

Which program are you applying for? *:

Sibling Applicant

First Name *:
Last Name *:
Birthday *:
Gender: