Enrollment Application – English

MCCC Interactive Enrollment Application - English
These Enrollment Applications are provided as interactive forms. Fill out the form and click "Confirm Signature". Your Enrollment Application file will be sent directly to the Mid-Columbia Children's Council personnel. You will be called to confirm your application.

NOTE: Parent/Guardian must meet with MCCC’s staff for an interview, provide proof of family’s income, proof of applicant’s date of birth, and proof of family size BEFORE this application can be processed.
NOTA: El padre o tutor debe reunirse con el personal de MCCC para una entrevista, presentar prueba de los ingresos de la familia, prueba de la fecha nacimiento del aplicante, y la una prueba de tamaño de la familia; PARA que esta aplicación pueda procesarse.

Please fill out the following section completely to facilitate selection decisions and our ability to contact you. Please notify us if your contact information changes after you send in your application.

Please provide First, Middle Initial and Last.
Living Address
Mailing Address
(Please provide written documentation from the professional serving your child.)

Applicants Family / Please list Parents/Guardians
Please list all other people living in your household supported by your income.
Please answer the following questions as completely as possible. It will help us determine the urgency of your family’s needs.
(Immediate family member is anyone related to the applicant by blood, marriage, or adoption).
(Attending medical appointments, buy groceries, take children to school, etc.)

Along with this application, please provide proof of income for all parents/guardians related to the child by blood, marriage, or adoption and are living in the same household. Provide the documentation needed for income age and family size at time of interview.

Application is incomplete without the required interview and documentation. Please make sure to bring your proof of income, age and family size at time of interview as soon as possible.

The Head Start program includes many family support services. Parents will be asked to work with the program by: Helping in classroom activities, participating in regular Home Visits, participating in Parent Committees and by obtaining regular health and dental care for their child.

In accordance with Federal law and U.S. Department of Agriculture policy this institution is prohibited from discrimination on the basis of race, color, national origin, sex, age, or disability.

The Mid-Columbia Children's Council requires that you certify your application by submitting an electronic signature. By typing your full name below and clicking Confirm Signature, you certify that all the information in the application and your signature is accurate and true.