Early Childhood Enrollment Application - Kootasca Community
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4Early Childhood Enrollment Application
KOOTASCA Head Start
201 NW 4th St, Suite 130 • Grand Rapids, MN 55744
Invest Early Project
st
218.999.0814 • Fax 999-0842
820 NW 1
Ave • Grand Rapids, MN 55744
218.327.5850 • Fax 327-5851
nd
2232 E 2
Ave • International Falls, MN 56649
218.283.9491 • Fax 283-9855
Itasca County
School Readiness / ECFE
Child Care & Early Childhood Programs
ISD 316 Greenway Schools • 218-247-7306
st
820 NW 1
Ave • Grand Rapids, MN 55744
ISD 317 Deer River Schools • 218-246-8860
218.327.5850 • Fax 327-5851
ISD 318 Grand Rapids Schools • 218-327-5850
Scholarships funded by MN's Race to the Top Early Learning Challenge Grant
ISD 319 Nashwauk-Keewatin • 218-885-1280; x52101
ISD 363 Northome * 218-897-5275 x152
Thank you for your interest in our Early Childhood Programs.
Please remember, in completing this application, you are applying for all the above programs.
Completing your application does not necessarily mean you have been accepted into any of these programs.
Please complete and return the following items:
Steps
Name of Document to be Completed
Action Required
1.
Tennessen Warning
Read carefully, sign, date & return.
Print clearly, completely fill-in, use
2.
Application for Enrollment
legal names, sign, date & return.
3.
Income Verification (
Return copies of all income
An interview with parent(s) will be
conducted)
a) □ Public Assistance – provide statement showing cash payments
sources from each Parent
b) □ Foster Care – provide placement letter
providing financial support for
c)
□ Supplemental Security Income (SSI) – provide award letter
applicant.
d) □ Homeless – provide Housing Questionnaire
e) □ Income Tax Return or W2 – provide copy of most recent year
f)
□ Pay Stub copies –
provide for last 3 months
g) □ Unemployment print-out of payments
h) □ Child Support / Alimony/ College Scholarship or Grants - provide
documentation.
i)
□ Award Letter from Social Security / Pension / Veteran’s Benefits /
Private Disability – provide documentation
j)
□ Self Employment - provide documentation.
k)
□ No Financial Resources - provide a personal, written letter that is
signed and dated from each adult who is supporting the applicant,
stating they have no income & explain how family is being
supported.
This is required for children who received
4.
Immunization Record for each applicant
their immunizations Out-of-State.
Thank you for mailing or delivering your fully completed application to one of the addresses below:
877.687.1163
Serving residents of
KOOTASCA Head Start
Barb Foss
218.999.0814
KOOTASCA Head
201 NW 4th St, Suite 130
Fax 999.0842
Grand Rapids MN 55744
Start Region
Invest Early Project
Lauri Camilli
218.327.5850
Serving residents of
st
820 NW 1
Ave
Fax 327.5851
Itasca County
Grand Rapids MN 55744
After your application is processed, we will contact you. Our Application process takes 45 days. Thank you for applying.
Upon request, this information will be made available in alternate formats, such as Braille, audiotape, computer disk or large print.
KOOTASCA Community Action Inc. and the Invest Early Project are both Equal Opportunity Provider’s and Employer’s.
Early Childhood Application Form 2016-2017
Revised 10/30/2015
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