Get Head Start Form

Filling out the Head Start Form is an important step in ensuring the well-being of your child in the program. This guide will help you navigate through each section of the form online, providing clear instructions for every field.

Follow the steps to complete the Head Start Form accurately

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the last name, first name, and middle initial of the child in the designated fields.
3. Indicate the sex of the child by selecting either 'M' for male or 'F' for female.
4. Enter the child's date of birth in the specified format.
5. Select the program in which your child is enrolled by checking either Head Start or Early Head Start and the base option.
6. Fill in the name of the parent or guardian in the designated area.
7. Provide the delegate agency name or site in the corresponding field.
8. Under the section for the dentist, type or print the dentist's name who administered the dental examination.
9. Have the dentist sign and fill in their telephone number and address.
10. Indicate whether a dental examination was performed by checking 'Yes' or 'No', and provide the date of the exam if applicable.
11. Specify if preventive dental care was provided and describe the preventive care in the respective field.
12. Select the dental diagnosis from the options given, including normal examination, cavities, or other diagnoses.
13. Indicate if dental treatment was initiated, and if so, describe the treatment details.
14. Check 'Yes' or 'No' to indicate if all dental treatment has been completed and provide the date of the next visit for treatment.
15. State the date the next routine dental examination is due.
16. For Head Start staff review, ensure the signature, position, and date are filled out by both staff members completing the review.
17. Finally, save your changes, then you can either download, print, or share the completed form as needed.

Ensure all necessary documents are filled out online to complete your application.