MEO HEAD START ENROLLMENT APPLICATION 2025

MEO HEAD START ENROLLMENT APPLICATION

2025-2026 School Year
Current Date

MonthDayYear
Date
This form is currently unavailable. Applications will be back online February 1, 2025. Contact the MEO Head Start office at 808-249-2988 if you have any questions.
Family ID#
Aloha,

Thank you for your interest in our MEO Head Start program! Please read these guidelines before completing an application for your child.
- Review the MEO Head Start Selection Criteria. By clicking the submit button, you agree to the program terms & conditions.
- Contact our Head Start office at (808) 249-2988 should you have any questions.
- Additional contact information should be someone other than the parents/legal guardians.
The following documents are required to complete your application for processing:
- Your child’s birth certificate, hospital certificate or other document verifying the child’s age.
- Income verification – Copy of your 2024 income tax returns (Form 1040 - submit the page that lists your name's, dependents, wage, salaries, tips, not the whole packet) OR all 2024 W-2 forms.
- When applicable - TANF (AFDC Benefit History), SSI, SNAP Benefit History, Foster Care, Homeless Verification.
- Visit https://pais-benefits.dhs.hawaii.gov to obtain a 6 month printout of your TANF and SNAP issued benefits.
Thank you!
Selection Criteria for School Year 2025-2026
CENTER OF PREFERENCE
Application will be Accepted for review*
Child's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Sex*

MaleFemale
Race*

WhiteMulti-Racial/Bi-RacialAfrican American or BlackAsianHawaiianPacific IslanderAmerican IndianAlaskan Native
Ethnicity: Hispanic or Latino*

YesNo
Primary Language Spoken at home*
Secondary Language Spoken at home*
Child's Health Information*

QuestCombined Medicaid/QuestMedicaidPrivateNo InsuranceOther
Insurance Provider*
Primary Care Physician*
Dentist*
Tell us about your child
Does your child have any current or chronic medical conditions? (Ex:asthma, food allergy, special diet, heart problems, seizures, etc.)*

YesNo
If you answered "Yes" to the question above, please list and explain
If you answered yes, would your child require medication during school hours?

YesNo
Does your child have any developmental concerns? (Ex: speech, hearing,vision, autism, injuries, etc.)*

YesNo
If you answered "Yes" to the question above, please list and explain
Does your child have a current Individual Education Plan (IEP)?*

YesNo
Check all that apply to your child and family.*

Behavioral or Social Emotional Concerns (Ex: anger, anxiety, biting, hitting)Domestic Abuse/ViolenceIncarcerated Parent or GuardianLegal documents - Custody, Divorce, Guardianship, Restraining OrderNone of the above
Family Information
Parental Status*

Single FemaleSingle MaleTwo Parent HouseholdNon-ParentGrandparentFosterRelative
Child Lives With*

Both ParentsMotherFatherGrandparentNon-ParentFoster
Custody - if not two parent household*

MotherFatherDual CustodyOther Custody
Total Number in Family - include all individuals financially supported by the applicant's parent or guardian(s)*
Living situation*

OwnRentPublic HousingPermanent housing shared with familyTemporary HousingTransitional housing, Emergency shelterHomelessOther
Services your family receives (Select all that apply)*

WICSNAPTANFSSIHUDCWSChild SupportNoneOther
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Living Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
(A01) Parent/Guardian Information
(A01) Parent/Guardian*

MotherFatherGrandparentFosterOther
(A01) Name*

First NameLast Name
(A01) Parent/Guardian Home Phone*
(A01) Parent/Guardian Work Phone*
(A01) Parent/Guardian Cell Phone*
(A01) Parent/Guardian Opt in for Text Messages*

YesNo
(A01) Email*
example@example.com
(A01) Date of Birth*

MonthDayYear
Date
(A01) Sex*

MaleFemale
(A01) Race*

WhiteMulti-Racial/Bi-RacialAfrican American or BlackAsianHawaiianPacific IslanderAmerican IndianAlaskan Native
(A01) Ethnicity: Hispanic or Latino*

YesNo
(A01) Current Employment Status*

Full-timePart-timeJob TrainingSchoolRetiredDisabledSeasonalUnemployedStay at home parentMember of US Military (Active Duty)Veteran of US Military
(A01) Hours of employment*
(example: Monday –Friday 7:30-3:30)
(A01) Highest Level of Education*

Grade 9 or lessGrade 10Grade 11Grade 12High School DiplomaGEDVocational SchoolSome CollegeAssociates DegreeBaccalaureate DegreeAdvanced Degree
(A01) Health Information*

QuestPrivateNone
(A01) Insurance Provider*
(A02) Parent/Guardian Information
(A02) Parent/Guardian

MotherFatherGrandparentFosterOther
(A02) Name

First NameLast Name
(A02) Parent/Guardian Home Phone
(A02) Parent/Guardian Work Phone
(A02) Parent/Guardian Cell Phone
(A02) Parent/Guardian Opt in for Text Messages

YesNo
(A02) Email
example@example.com
(A02) Date of Birth

MonthDayYear
Date
(A02) Sex

MaleFemale
(A02) Race

WhiteMulti-Racial/Bi-RacialAfrican American or BlackAsianHawaiianPacific IslanderAmerican IndianAlaskan Native
(A02) Ethnicity: Hispanic or Latino

YesNo
(A02) Current Employment Status

Full-timePart-timeJob TrainingSchoolRetiredDisabledSeasonalUnemployedStay at home parentMember of US Military (Active Duty)Veteran of US Military
(A02) Hours of employment
(example: Monday –Friday 7:30-3:30)
(A02) Highest Level of Education

Grade 9 or lessGrade 10Grade 11Grade 12High School DiplomaGEDVocational SchoolSome CollegeAssociates DegreeBaccalaureate DegreeAdvanced Degree
(A02) Health Information

QuestPrivateNone
(A02) Insurance Provider
Additional dependents supported by Parent(s) or Guardian(s)
Additional Contact Information (Name, Address, Phone)*
You may upload required documents below, email to hsapp@meoinc.org, or drop off at the MEO Head Start office.
You may upload required documents here, in the form of Photos or PDF files*

Browse Files

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Parent/Guardian’s Signature*

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MEO HEAD START ENROLLMENT APPLICATION

Selection Criteria for School Year 2025-2026

Tell us about your child

Family Information

(A01) Parent/Guardian Information

(A02) Parent/Guardian Information