Eligibility Inquiry Form - Guam Head Start Program

Head Start Program Eligibility Inquiry

Complete this form if you are interested in enrolling your child into the Guam Head Start Program. Head Start Family Services Staff will contact you and schedule an appointment to review your documents and determine your child's eligibility for Head Start.

* Means required field

PERSON COMPLETING THIS FORM

Individual Completing this Form is…* A Parent or Guardian of the child/childrenOther

Relationship to the child/children*

First Name*

Last Name*

Email Address*

Contact Number(s) (Area Code - Phone Number)*

HOUSEHOLD INFO AND AGE VERIFICATION

Select Type of Household* One-Parent HouseholdTwo-Parent Household

Number of Children to Register*

I AGREE TO THE TERMS & CONDITIONS *

You must agree to the Terms & Conditions before you can click the submit button.

Oops, some items need your attention. Please check the items marked in red in the form below.

PERSON COMPLETING THIS FORM

HOUSEHOLD INFO AND AGE VERIFICATION

PARENT/GUARDIAN INFORMATION

OTHER PARENT/GUARDIAN INFORMATION

CHILD 1: INFORMATION

CHILD 2: INFORMATION

CHILD 3: INFORMATION