Indiana County Head Start Enrollment Application  
FOR RESIDENTS OF INDIANA COUNTY PENNSYLVANIA ONLY

There is no cost for our program!

If your family receives SNAP, your child is automatically eligible for Head Start and Early Head Start services!   

Sign in to Google to save your progress. Learn more
Email *
Which program are you interested in? (Required) *
Required
Parent/Guardian's Name  (Required) *
Phone Number  (Required) *
What is the best time to contact you?  (Required) *
Required
Indiana County, PA Address (number, street, city, state, zip code)  (Required) *
Child/Children's Date of Birth  (Required) *
Child/Children's Names  (Required) *
How did you hear about Indiana County Head Start?  (Required) *
Indiana County, PA Township  (Required) *
Indiana County, PA School District  (Required) *
Approximate Income  (Required) *
Select From The Following  (Required) *
Required
Select All That Apply  (Required) *
Required
Optional: Child/Children's Special Needs/Referral 
Optional: Family's Special Needs/Referral 
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Indiana County Head Start. Report Abuse
Google Forms