Application Miami-Dade Community Action And Human Services Department Head Start / Early Head Start Family Information printable pdf download

0 – 5 YEARS OLD

MIAMI DADE COUNTY COMMUNITY ACTION AND HUMAN SERVICES DEPARTMENT

HEAD START/EARLY HEAD START

REGISTRATION REQUIREMENTS

(Parent(s))/Legal Guardian Copy)

The following documentation is needed at the time of the application intake, if applicable. This information is used to

determine program eligibility. Provide copies of documents if any of the items checked “yes” on the family circumstances

checklist listed on page 3 of the application. Staff is available to assist with the completion of the application. Check

documentation provided to staff.

Proof of Age:

Birth Certificate

EHS- Pregnant women. Birth to age 3 years after

Passport

September 1, 2013.

Notarized Affidavit of Age Form

HS- Children must be 3 or 4 years of age on or before

Doctor’s statement (pregnant women)

September 1, 2013, or no more than five (5) years old

after September 1, 2013.

Proof of parent’s/legal guardian gross income for

Signed Income Form Tax 1040 (with eligible child name

the past 12 months or the last calendar year (2012).

listed)

W-2 forms

pay stubs

Unemployment Compensation

Written statement from employers

Social Security Supplemental Income (SSI) printout

TANF print out

Child Support

Income Statement

Proof of Parent’s Identification

Driver’s license/Passport

State issued picture I.D.

Employer issued I.D./Military ID

Homeless Shelter ID

Driver’s license

Proof of Dade County Residency

State issued picture I.D. with address listed

Utility Bills (lights, phone, cable, etc)

Lease/Rental and Mortgage Agreement

TANF/SSI/Unemployment Letter

Proof of Disability

Individualized Educational Plan (IEP)

Individualized Family Support Plan IFSP

Proof of Suspected Disability

Doctor/Therapist evaluations and statements outlining

concerns

Proof of Homelessness Verification

Statement from homeless facility or social worker

Statement from applicant

Proof of Substance Abuse

Statement from Treatment Program Staff

Proof of Domestic Violence

Statement from Domestic Violence Agency/Staff

Court Documentation (within the last year)

Proof of Student Status

Current Transcript

Proof of Education Eight Grade and Below

Statement from Applicant/Official School Transcript

SSI Recipient Letter/Doctor’s Statement

Proof of Parental Disability

Proof of Pregnancy

Medical Documentation (current)

Proof of Public Housing Residency

MDPHA Rental/Lease Agreement

Proof of Foster Care-Legal Custody

Documentation from Foster Care Agency/Court Award

Proof of Legal Guardianship/Custody

Documentation from the Court System/Court Award

Parents will certify that the information provided on the application and supporting documentation is true and correct and that all

parent(s)/legal guardian(s) income are reported. Deliberate misrepresentation of any information submitted may be subject to the

child being terminated from the program. An incomplete application and documentation will delay the enrollment process.

Application Miami-Dade Community Action And Human Services Department Head Start / Early Head Start Family Information

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