HEAD START/EARLY HEADSTART ENROLLMENT …

G:\ERSEA\Forms\ head start \ head start -Early head start ENROLLMENT Application Revised. 1/11/17 head start & EARLY head start ENROLLMENT APPLICATION THE CHILD S INFORMATION EHS-CCP EHS HS LIFT Child s Legal Name First Middle Initial Last Child s Place of Birth (City, State) Child s DOB (mm/dd/yyyy) Sex Child s Ethnicity Latino Yes No Child s Race Pacific Islander Black White Biracial/ Multi Nat. Amer. Asian Other_____ Child s Primary Language English Spanish Vietnamese Other _____ Child s Secondary Language English Spanish Vietnamese Other _____ THE CHILD S HOUSEHOLD FAMILY INFORMATION 1 Primary adult name Latino?

G:\ERSEA\Forms\Head Start\Head Start-Early Head Start Enrollment Application English.doc Revised.12/19/2018 HEAD START & EARLY HEAD START ENROLLMENT APPLICATION THE CHILD’S INFORMATION EHS-CCP EHS HS LIFT Child’s Legal Name First Middle Initial Last

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  Applications, Start, Heads, Enrollment, Head start enrollment application, Head start

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