Head Start Application English

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Are there other adults in the household?

Family Information

Child (Applicant)

This application can also be filled out for mothers who are pregnant. If you are applying as a pregnant mother, please put the new child's first and last name and the anticipated date of birth for your child where required.

Location Preferences

Additional Applicant

Siblings

Contact us

711 W. McBean St.
Peoria, IL 61605

Tel: (309) 671-3900

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