Boston Head Start | Pre-Application Form

Pre-Application Form

Name of Parent:
Name of Child:
Child's Date of Birth:
Street Address:
Boston Neighborhood:
E-Mail Address:
ZIP Code
Daytime Phone
Age of Child on 9/1/09
Are you aware of income guidelines for Head Start?	Yes No
Have you registered for the Massachusetts child care wait list?	Yes No
How did you hear about Head Start?	MBTA Newspaper ABCD Affiliate Friends / Family Church Other