• Child Application for Head Start / Early Head Start

    Thank you for your interest in our free program. Please fill out the following application for our program. We use a secured platform to ensure any information provided and documents uploaded maintain the highest level of confidentiality.
  • You must also submit the following: Documentation of your family's income (most recent 1040 or W2s, most recent pay stubs, SSI letter, DHHS letter for cash or food assistance, etc); Your child's current physical; Your child's up to date immunization record or waiver from the Genesee Co Health Dept; Your child's Birth Certificate, Birth Record, or Affidavit of Parentage. You can attach these documents to this application electronically, fax them to 810-341-5852, or send through the United States Postal Service to GCCARD Head Start at 711 N. Saginaw Street, Suite 1B, Flint, MI 48503.
  • Please remember that our staff are not in the office every day, but will process the information you provide as quickly as we can. Your child will NOT be considered for placement into our program without the required documents listed above. Placement in our program is contingent on the availability of funding and is based on the Head Start regulations as well as our locally designed selection criteria. We look forward to working with you in regards to enrolling your child.
  • Parent/Guardian Information

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  • Child's Information

    Please fill this section out for the child you are applying for (if you are applying for more than one child you will need to fill out a separate application for each of them)
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  • Family Members In Household

    Please list all other family members living in the household
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  • Additional Family Members in Household

    Please list any additional family members living in the household you did include on the previous page
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  • Medical/Miscellaneous

  • Program Needs

  • Additional Documentation

    All additional documents described below can be submitted by attaching them to this application electronically, by fax to 810-341-5852, or by U.S. mail to GCCARD Head Start 601 N. Saginaw St., Suite 1B, Flint, MI 48502.
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  • Parental Permission

    I understand that by applying to Early Head Start/Head Start for my child I agree to the following:
  • Center Base: My child will attend class regularly and I will notify the center of the reason for any absences; two Home Visits and two Parent/Teacher Conferences will be scheduled during the program year at my convenience.
  • Home Base: I agree to participate in weekly home visits and attend socialization experiences twice per month.
  • General: Pictures, photographs, or video tapes of my child may be taken while participating in Head Start activities and I expressly waive the right of privacy and consent to such taking; my child may participate in all health activities including: dental, visual, hearing, mental health observations and consultations, and developmental screenings/examinations given as a part of the Head Start program (at no cost to me); in care of emergency, I give my consent to have Head Start staff secure needed emergency medical care, if parents or guardians cannot be immediately contacted; information in my child's personal file may be reviewed by government officials; necessary records may be released/transferred to the school system, GSRP, or other Head Start program that my child will attend after leaving the Head Start program; I agree to participate as a volunteer in the Head Start program.
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  • Application Complete

    Thank you for applying for GCCARD Head Start/Early Head Start. In order to process your application we also need proof of all household income. If you have not attached them to this application already, please submit them via fax (810-341-5852) or through the United States Postal Service to GCCARD Head Start at 711 N. Saginaw Street, Suite 1B, Flint, MI 48502. While we also require documentation for birth verification, child's current physical, and immunization records we understand those may be difficult to obtain at this time. If you have them available please submit them along with your income documentation, or they can be collected at a later time.
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