GEMINUS HEAD START & EARLY HEAD START PROGRAMS ARE NOW ACCEPTING APPLICATIONS FOR THE 2012-2013 SCHOOL YEAR Applications are now being accepted for the Geminus Head Start and Early Head Start Programs Eligibility for this comprehensive pre-school program is determined in the following way: Head Start:
1.Must be 3 by August 1 of current year (Birth Certificate required) 2. Present a copy of your child’s immunization record 3. Document your income for the past 12 months (W-2’s—Tax return--SSI---TANF documentation---Child Support---Pay Stubs---Unemployment Compensation) 4. Children with disabilities ( IEP’s) are also eligible
Early Head Start: Pregnant women and children from birth to age 3 are eligible. 1. Present a copy of Birth Certificate 2. Immunization record required 3. Income documentation required for last 12 months 4. Children with IFSP’s are also eligible Neither of the above programs charges any fees. Eligibility is based on income using the Federal Poverty Level Guidelines. You will then be contacted to set up an appointment to register. Limited Transportation is available for AM/PM sessions. Name:______________________________________________________________________________ Address:____________________________________________________________________________ Phone: Number: _____________________________ Cell Phone:____________________ Child’s Name: ________________________________
Date of Birth:______________
I am interested in: _____ AM Session (Monday-Thurs)
_____ PM Session (Monday-Thurs)
_____ Home Based services
_____ 6hr Session (Monday-Fri)
_____ Early Head Start (Home Based)
________Early Head Start (Site based—Hobart, Indiana) Referred by: ___________________________________________________________________________