Family And Early Childhood Education Program/head Start/early Head Start Application Page 4
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4Section 7: How did you hear about the program?
Check all that apply:
Family/friend
School
Social service agency (DFS)
FCPS Website
Child Find office
Older child was in program
Flyer/poster
FCPS Student Registration
Other (please specify)
Section 8: Statement of Certification
I understand that as an applicant for this program, I must provide information on my
income. I understand that program staff reserves the right to review this information and to
make eligibility determinations for this program. I certify that the information provided by
this application is true and accurate to the best of my knowledge. I understand that if I
knowingly provide false/conflicting information, my child will be found ineligible for the
FECEP/Head Start/Early Head Start program.
Parent/Legal Guardian Signature:
Date:
Parent/Legal Guardian Print Name:
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