Palo Verde Head Start

2021/2022 Head Start Enrollment Checklist

*Pre-registration does not guarantee enrollment

To process the application, you must bring the following documentation along with the application packet.

• Application
• Birth Certificate for child (3, 4, or 5 years of age)
• 2021 Income Tax or W2 forms if not filed
• Last pay stub from employer (if employed in different jobs, must bring pay check stubs from all jobs, including spouse)
• If receiving unemployment, must bring in all stubs or report for the past 12 months (EDD Report)
• Passport of Services; if receiving financial assistance (TANF/Cal-Works)
• If you are receiving child support: Bring proof for last 12 months from child support office or court ordered paperwork
• If you are a single parent, not receiving child support we need the absent parent’s income
• Social Security letter with amount received monthly
• Proof of Residency (current utility bill, rental agreement, etc.)
• Immunization Record
• Copy of complete Physical Exam (with TB clearance, Lead and Hemoglobin results) for child enrolling (valid for 12 months)
• If your child has any Allergies or Medical Conditions, we will need the following:
  • Physician Information (name, phone number, and address)/ Care Plan
  • If under medication, Consent for medication form needed (see Health Technician for form)
  • Complete medical statement by physician (see Health Technician for form)
• If your child has an IEP (Individualized Education Plan): Please Bring Copy
• If you have an Active Restraining Order: Must Bring a Copy

Our program does not discriminate children who are not potty-trained.
2021/2022 Head Start POVERTY GUIDELINES FOR THE 48 CONTINUOUS STATES AND THE DISTRICT OF COLUMBIA
(Income over $ amounts do not qualify)

For families with more than 8 persons, add $4,720 for each additional person.

For Additional Information, Please Contact our Office at: 760-922-8454

This program operates on a nondiscriminatory basis and gives equal opportunity to service without 
regards to race, sex, creed, religion, national origin, ancestry or legal status.