CNMI PSS Head Start/Early Head Start School Year 2026-2027 Application for Enrollment

Important Application Instructions & Information

Before you begin your application, please review the following critical program requirements and submission guidelines:

Who Can Submit an Application?
Applications must be submitted by the child's parent or legal guardian.

Age Eligibility
Please review the age criteria below to ensure your child is age eligible for our programs:

Early Head Start: Enrolls infants and toddlers from 6 weeks to 36 months old.

Head Start: Enrolls preschool-aged children from 3 to 5 years old.

Kindergarten Eligibility Note: Children born on or before September 30, 2021, are age-eligible for kindergarten and should register with their local elementary school rather than Head Start.

Required Application Documents
The following documents are required for upload when submitting your child's application. Please have the following documents ready to be uploaded:

Proof of Child’s Age—Acceptable documents may include a birth certificate, passport, or other official document verifying the child’s date of birth, as approved by the program.
Parent/Guardian Identification—Acceptable valid government-issued identification may include a driver’s license, mayor's ID, passport, or other official identification for each parent.
Eligibility Documentation—Families must provide documentation from one of the following eligibility categories:
- Proof of income, such as:
  - Income tax return
  - W-2
  - Past 12 months of check stubs
  - Employer verification (Note: Selecting this means we will email you the required form to complete).
  - Declaration of Zero Income & Financial Support (Note: Selecting this means we will email you the required form to complete).
- Nutrition Assistance Program verification (certification letter or yellow card)
- Foster care documentation
- Supplemental Security Income verification
- Written statement regarding displacement or unhoused status
Special Services Documentation—Copy of your child's IEP or IFSP if they have one; you can still submit your application today without it, and our team will help you gather it later.

Application Review
Please ensure all sections are filled out and all supporting documents are attached. Incomplete applications will not be screened or processed for eligibility.

Health Documents Submission
Families will be provided with the health forms upon completion of the eligibility determination. Program health forms and a valid school health entrance certificate are required prior to enrollment.

Contact Us
We are here to help! Connect with our Family Services team for additional program details or for application assistance.

Saipan: 664-3761, 323-7446, 287-9946, or 287-9981

Tinian: 433-4620 or 287-9934

Rota: 532-0484 or 287-9040

Email: hsehs@cnmipss.org

Please be advised that the CNMI PSS Head Start/Early Head Start Program is a federally funded program that has eligibility and selection criteria requirements. Submission of your child's application does not guarantee automatic enrollment. The program does not provide transportation.

Child's Legal Name

First NameMiddle NameLast NameSuffix

Child Date of Birth

Proof of Child's Age

Child Gender

Child's Race (select all that apply)

Who does your child live with?

Is your child in a dual custody arrangement?

If in dual custody, please describe the arrangement.

Child's first home language

Child’s other home language(s)

What language does your child feel most comfortable using?

Child’s Medical Insurance

If your child has private medical insurance, provide name of insurance company:

Child’s Dental Insurance

If your child has private dental insurance, provide name of insurance company:

Child's Doctor/Medical Clinic

Child's Dentist/Dental Clinic

Has your child been DIAGNOSED by a health care provider as having a health condition, special health care needs, or allergies?

If yes, diagnosed condition / details

Children with special health care needs are required to have a Child Health Care Plan in place.

Does your child have a special need?

IEP/IFSP Start Date

If you indicated your child has an IEP or IFSP, please upload the documentation.

Do you have a developmental concern about your child’s development?

If yes to developmental concerns, check all concerns that apply.

Other

Has your child experienced any of the following? Please check all that apply.

Is your child currently in foster care?

Tell us a little bit about your child! Please feel free to share their likes, strengths, special needs, or any other information about their life at home that would help our program best support them:

Have there been any changes or challenges in your child’s life over the past three years that we can help them navigate? (Check all that apply to help us best support your child)

Are there specific times or activities when your child tends to get frustrated or upset? (Check all that apply):

Please share any other times or situations where your child might need a little extra comfort or support:

Child's Country of Citizenship

Child's citizenship is collected for data purposes only and NOT a condition for enrollment into HS/EHS.

If Citizenship is Other, please indicate country

Child's Legal Name

First NameMiddle NameLast NameSuffix

Child Date of Birth

Proof of Child's Age

Child Gender

Child's Race (select all that apply)

Who does your child live with?

Is your child in a dual custody arrangement?

If in dual custody, please describe the arrangement.

Child's first home language

Child’s other home language(s)

What language does your child feel most comfortable using?

Child’s Medical Insurance

If your child has private medical insurance, provide name of insurance company:

Child’s Dental Insurance

If your child has private dental insurance, provide name of insurance company:

Child's Doctor/Medical Clinic

Child's Dentist/Dental Clinic

Has your child been DIAGNOSED by a health care provider as having a health condition, special health care needs, or allergies?

If yes, diagnosed condition / details

Children with special health care needs are required to have a Child Health Care Plan in place.

Does your child have a special need?

IEP/IFSP Start Date

If you indicated your child has an IEP or IFSP, please upload the documentation.

Do you have a developmental concern about your child’s development?

If yes to developmental concerns, check all concerns that apply.

Other

Has your child experienced any of the following? Please check all that apply.

Is your child currently in foster care?

Tell us a little bit about your child! Please feel free to share their likes, strengths, special needs, or any other information about their life at home that would help our program best support them:

Have there been any changes or challenges in your child’s life over the past three years that we can help them navigate? (Check all that apply to help us best support your child)

Are there specific times or activities when your child tends to get frustrated or upset? (Check all that apply):

Please share any other times or situations where your child might need a little extra comfort or support:

Child's Country of Citizenship

Child's citizenship is collected for data purposes only and NOT a condition for enrollment into HS/EHS.

If Citizenship is Other, please indicate country

Child's Legal Name

First NameMiddle NameLast NameSuffix

Child Date of Birth

Proof of Child's Age

Child Gender

Child's Race (select all that apply)

Who does your child live with?

Is your child in a dual custody arrangement?

If in dual custody, please describe the arrangement.

Child's first home language

Child’s other home language(s)

What language does your child feel most comfortable using?

Child’s Medical Insurance

If your child has private medical insurance, provide name of insurance company:

Child’s Dental Insurance

If your child has private dental insurance, provide name of insurance company:

Child's Doctor/Medical Clinic

Child's Dentist/Dental Clinic

Has your child been DIAGNOSED by a health care provider as having a health condition, special health care needs, or allergies?

If yes, diagnosed condition / details

Children with special health care needs are required to have a Child Health Care Plan in place.

Does your child have a special need?

IEP/IFSP Start Date

If you indicated your child has an IEP or IFSP, please upload the documentation.

Do you have a developmental concern about your child’s development?

If yes to developmental concerns, check all concerns that apply.

Other

Has your child experienced any of the following? Please check all that apply.

Is your child currently in foster care?

Tell us a little bit about your child! Please feel free to share their likes, strengths, special needs, or any other information about their life at home that would help our program best support them:

Have there been any changes or challenges in your child’s life over the past three years that we can help them navigate? (Check all that apply to help us best support your child)

Are there specific times or activities when your child tends to get frustrated or upset? (Check all that apply):

Please share any other times or situations where your child might need a little extra comfort or support:

Child's Country of Citizenship

Child's citizenship is collected for data purposes only and NOT a condition for enrollment into HS/EHS.

If Citizenship is Other, please indicate country

Primary Adult: Full Name

First NameMiddle NameLast NameSuffix

Primary Adult: Date of Birth

Primary Adult: Gender

Primary Adult: Valid Identification

Primary Adult: Race (select all that apply)

Primary Adult: Relationship to Child

Relationship to Child - Other, please specify

Primary Adult: Do you have legal custody of the child?

Primary Adult: Do you live in the same household as the child?

Primary Adult: Primary Language

Primary Adult: English Proficiency

Primary Adult: Other Language

Primary Adult: Other Language Proficiency

Primary Adult: Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Primary Adult: Email

Primary Adult: Employment Status

Primary Adult: Place of Employment

Primary Adult: Currently in School

Primary Adult: Education Level

Primary Adult: In a job-related training program?

Primary Adult: United States Military Service

Secondary Adult: Full Name

First NameMiddle NameLast NameSuffix

Secondary Adult: Date of Birth

Date of Birth

Secondary Adult: Gender

Secondary Adult: Valid Identification

Secondary Adult: Race (select all that apply)

Secondary Adult: Relationship to Child

Relationship to Child - Other, please specify

Secondary Adult: Do you have legal custody of the child?

Secondary Adult: Do you live in the same household as the child?

Secondary Adult: Primary Language

Secondary Adult: English Proficiency

Secondary Adult: Other Language

Secondary Adult: Other Language Proficiency

Secondary Adult: Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Adult: Email

Secondary Adult: Employment Status

Secondary Adult: Place of Employment

Secondary Adult: Currently in School

Secondary Adult:Education Level

Secondary Adult: In a job-related training program?

Secondary Adult: United States Military Service

Living Address – House # & Street Name

Include an apartment/unit number, if applicable

Living Address - Village Name

Residence Document or Location Map

Nearby Landmark or Directions

Mailing Address

MPCountry

Primary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Secondary Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

How many family members live in your household?

Other household members will be added to the application below.

What is your family's current housing status?

If your family's housing status is temporary, including living with family/friends, in a shelter, tent, or other, please describe

Does your family receive Food Stamp/NAP benefits?

Is any family member who lives in the same household as the child receiving Supplemental Security Income?

SSI recipient relationship to the child applicant

Does your family receive WIC?

If yes, please provide WIC ID number

Is this application for a child receiving DCCA CCDF Child Care Subsidy?

Child referred to program by another agency?

If yes, which agency made the referral?

Are there any specific family needs or critical situations you would like our staff to be aware of at this time?

If yes, please describe any current family needs or urgent challenges you are facing:

Other household members are individuals living in the home supported by the applicant child(ren)'s parents/guardians. Only include household members who are not the applicant child(ren) or parent(s)/guardian(s).

How many other household members live in your home. Do not include your applicant child(ren) and parent(s)/guardian(s) in this count.

Other Household Member 1: Full Name

First NameMiddle NameLast Name

Other Household Member 1: Relationship

Other Household Member 1: Date of Birth

Date

Other Household Member 1: Gender

Other Household Member 2: Full Name

First NameMiddle NameLast Name

Other Household Member 2: Relationship

Other Household Member 2: Date of Birth

Date

Other Household Member 2: Gender

Other Household Member 3: Full Name

First NameMiddle NameLast Name

Other Household Member 3: Relationship

Other Household Member 3: Date of Birth

Date

Other Household Member 3: Gender

Other Household Member 4: Full Name

First NameMiddle NameLast Name

Other Household Member 4: Relationship

Other Household Member 4: Date of Birth

Date

Other Household Member 4: Gender

Other Household Member 5: Full Name

First NameMiddle NameLast Name

Other Household Member 5: Relationship

Other Household Member 5: Date of Birth

Date

Other Household Member 5: Gender

Other Household Member 6: Full Name

First NameMiddle NameLast Name

Other Household Member 6: Relationship

Other Household Member 6: Date of Birth

Date

Other Household Member 6: Gender

Other Household Member 7: Full Name

First NameMiddle NameLast Name

Other Household Member 7: Relationship

Other Household Member 7: Date of Birth

Date

Other Household Member 7: Gender

Other Household Member 8: Full Name

First NameMiddle NameLast Name

Other Household Member 8: Relationship

Other Household Member 8: Date of Birth

Date

Other Household Member 8: Gender

Other Household Member 9: Full Name

First NameMiddle NameLast Name

Other Household Member 9: Relationship

Other Household Member 9: Date of Birth

Date

Other Household Member 9: Gender

Other Household Member 10: Full Name

First NameMiddle NameLast Name

Other Household Member 10: Relationship

Other Household Member 10: Date of Birth

Date

Other Household Member 10: Gender

Please select ONE option below that best fits your family's current situation.

Upload your document

Because you reported no income at this time, we will reach out to you with a short 'Zero Income' form to complete. This helps us ensure we have all the correct details to process your application as quickly as possible.

Because you selected this option, we will send you an official Employer Verification form. You will just need to have your employer fill it out and sign it to confirm your income, then return it to us to complete your application.

Emergency contacts are trusted adults we can contact if the parents or guardians cannot be reached.

Emergency Contact 1: Full Name

First NameMiddle NameLast Name

Emergency Contact 1: Relationship

Emergency Contact 1: Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact 1: Living Address

House #/Unit #/Street Name/Village

Emergency Contact 1: Consent

Emergency Contact 2: Full Name

First NameMiddle NameLast Name

Emergency Contact 2: Relationship

Emergency Contact 2: Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact 2: Living Address

House #/Unit #/Street Name/Village

Emergency Contact 2: Consent

Certification of Eligibility and Income

I certify that all information, household details, and income reported in this application are true, accurate, and complete. I understand that this program is funded by Federal grants and that eligibility is verified in accordance with Federal Head Start Performance Standards (45 CFR §1302.12). I understand that intentionally providing false, misleading, or inaccurate information to incorrectly qualify for services may result in my child losing their enrollment spot in the program and could subject me to legal prosecution under local and Federal laws.

Confidentiality & Record Access
In compliance with Head Start privacy regulations, all information provided in this application will be kept strictly confidential within the agency. As a parent or guardian, you have the right to access and review your child’s eligibility determination record at any time during our normal business hours.

Non-Discrimination Statement
This Head Start program operates in compliance with Federal civil rights laws. We warmly welcome all families and do not discriminate on the basis of race, color, national origin, gender, religion, or disability.

Parent/Guardian Name

First NameLast Name

Parent/Guardian Signature

How did you hear about us?

Other

School Year 2026-2027 Application for Enrollment

Child Applicant Information

Primary Adult: Parent/Guardian Information

Secondary Adult: Parent/Guardian Information

Family Information

Other Household Members

Upload Eligibility Documentation

Emergency Contacts

Head Start Terms & Eligibility Affirmation