CSD Interest Form

Gads Hill Center is now accepting* children ages 6 weeks to 5 years old for our Head Start and Early Head Start programs. Our center-based or home visiting offer full-day programming to children that include:
- Creative Curriculum
- Mental Health Support for Children and Families
- Parent Education and Engagement Activities
- Qualified, Bilingual (English & Spanish) Teaching Staff
- Extended Hours and Healthy Meals
If you are interested in learning more and getting in touch with our enrollment specialists, please take a minute to fill out the interest form below.
*Acceptance is based on families meeting pre-qualifications and open availability in our programs. Gads Hill Center enrollment specialists will assist and direct families in the process.
Enrollment Interest Form
What program are you interested in?

Center Base- Head Start/Early Head StartHome Visiting- Prenatal, age 0-3 and age 3-5
If applicable, which center are you interested in?

Gads Hill Center - North Lawndale neighborhood 2653 W. Ogden Ave. (age 2 to 5)Gads Hill Center - Chicago Lawn neighborhood 3137 W. 71st St. (age 2 to 5)Gads Hill Center - Brighton Park neighborhood 4255 S. Archer Ave. (age 6 weeks to 5)GHC Partner Network - Literacy Zone, 5831 S. Western Ave (age 2 to 5)GHC Partner Network - M & E Daycare, 3728 W. 79th St. (age 3 to 5)GHC Partner Network - Diana`s Playpen, 6236 S. Western Ave. (age 2 to 5)GHC Partner Network - Kiddie College, 8046 S. Western Ave. (age 2 to 5)GHC Partner Network - Peachtree 2 Educational Daycare, 1431 W. 111th St. (age 2 to 5)
Parent Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Are you currently employed?*

YesNo
Are you currently a student?*

YesNo
Are you currently receiving these benefits?

TANFSNAP (Food Stamps)WICSSII am not receiving benefits
What is your family size? How many adults and children?*
What is your estimated gross income?*
Child Name*

First NameLast Name
Child Birth Date

MonthDayYear
Has your child attended a program at Gads Hill Center before? If so, what program?*
Is your child currently enrolled in a early childhood program or attend school? If so, what program or school?*
How did you learn about Gads Hill Center?

RadioSocial MediaNewspaperGads Hill Center NewsletterCommunity EventFriend or FamilyOther
Please inform us of any other vital information you think they may need to know. Thank you.
Should be Empty:

Enrollment Interest Form