Online Application
For information on our Head Start, Early Head Start and Pre-K Counts programs please complete the following form. Once the form is submitted, a recruitment staff person will be in contact with you. The submission of this form does not guarantee your child will be admitted into the program.

Applications are accepted all year long for Head Start, Early Head Start and Pre-K Counts programming in both Luzerne and Wyoming counties. Recruitment season for our preschool program begins in January for the following school year.
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Parent/Guardian
First Name *
Last Name *
Date of Birth
MM
/
DD
/
YYYY
Gender
E-Mail *
Phone/Cell Number *
Opt In for Text Messages
Parent/Legal Guardian Address Line 1 *
Parent/Legal Guardian Address Line 2
City *
State *
Zip Code *
Do they need a Spanish Speaking Recruiter? *
Race
Hispanic
English Proficiency
Other Language
Child's Relationship
Custody
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