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Pre Registration Form

South Bronx Head Start Pre-Registration Form
Choose Your Site
Sessions/ Sesiones: Monday-Friday/ Lunes-Viernes
Child's Name/Nombre del Nino/a
Address/Direccion:
Telephone/Telefono:
Date of Birth/Fecha de Nacimiento:
Public Assistance/ Asistencia Publica:
Employed/Empleo:
Medicaid:
Income/ Ingreso (Annual Amount/ Cantidad Anual)
Other/Otro:
Head Start Income Eligible:
Head Start Ingreso Eligible:
CACFP Income Eligible:
CACFP Ingreso Eligible:
Family Size/ Tamano de Familia:
Adults/Adultos:
Children/Ninos:
Ethnicity/ Cultura
Special Concerns/ Impedimientos
Why do you feel your child should be in "Head Start Program"?
Explique su razon por cual piensa que su nino/a debe asistir al "Programa de Head Start"
Pre-Registered By/ Pre-Registrado Por:
Date/Fecha:

 

 

Who is eligible?

In order to qualify for our program, children must meet Federal Head Start eligibility requirements for age and income requirements. 

 

 

2013 Poverty Guidelines for the 48 Contiguous States and the District of Columbia

 

Persons in family/household

Poverty guideline

 

For families/households with more than 8 persons, add $4,020 for each additional person.

1               $11,490   

2               $15,510   

3               $19,530   

4               $23,550   

5               $27,570   

6               $31,590   

7               $35,610   

8               $39,630