Apply Online

Thank you for your interest in the Montgomery Community Action Head Start Program! Please complete the application below to enroll your child Early Head Start, Head Start, and Head Start Pre-K. The school year age cutoff date for all programs is September 1. If you have any questions, please call us at 334-269-2229.

Homeless children, foster children, and children with disabilities/special needs are given the highest priority for enrollment. Documentation is required for all disabilities/special needs. We also provide services for children and families that are learning english as a second language.

The following documents are required to complete enrollment: parent's photo ID, child's birth certificate, child's medical insurance card, and/or proof of income (if applicable) for the previous calendar year or preceding 12 months (SNAP, WIC, TANF, SSI, DHR, W-2, tax return, social security letter, unemployment letter, military benefits, child support, etc.).

If you are interested in our Pre-K classrooms, you will have to complete an additional application here: https://prek.alaceed.alabama.gov/ https://prek.alaceed.alabama.gov/

If you have any questions, please call us at (334) 269-2229 or visit 1021 Highland Avenue. Our office is open Monday-Thursday 9:00 a.m.- 4:00 p.m. & by appointment for your convenience.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Only enter information for a person who is a member of the household and provides financial support to the child.

Is there another parent/guardian in the family?

First Name (Required)

Last Name (Required)

Suffix

Birthday (Required)

Gender

Email Address

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

This section refers to the family that is responsible for financially supporting the child (Mother, Father, and/or legal guardian). The definition of "family" in the Head Start regulations includes all persons living in the same household who are supported by the income of the parent(s) or guardian(s) of the child enrolling or participating in the Head Start program and who are "related to the parent(s) or guardian(s) by blood, marriage, or adoption" (45 CFR 1305.2(e)).

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

WIC ID (if applicable)

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

Add Emergency Contact

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Insurance Number

Medicaid Eligibility

Medicaid Number

Doctor/Medical Home

Dental Coverage

Dental Coverage Number

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

Thank you for completing the first portion of the application process to express interest! A Family Advocate will contact you to continue the enrollment process. If you have any questions, please call us at 334-269-2229 or visit 1021 Highland Avenue. We will work with you to remove any barriers to enrolling your child. Our office is open Monday-Friday 8:30 a.m.- 4:30 p.m. and by appointment to accommodate your needs.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings