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Higher Horizons Head Start is located in Fairfax County, VA. Do you live in Fairfax County?(Required)

IF NO PLEASE DO NOT FILL OUT THE FORM. Service Area Zip Codes: 22041, 22042, 22044, 22003, 22030

We offer several programs at Higher Horizons Head Start and Early Head Start. Which of our programs are you interested in? (Select all that apply)

Early Head Start (Children 0-3 years old)

Head Start (Children 3-5 years old)

Home Based (Children 0-3 years old and Expectant Mothers)

Primary Parent's Name (First & Last)(Required)

Secondary Parent's Name (First & Last)

Phone number(Required)

Home Address(Required)

Street Address Address Line 2 City State ZIP Code

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Children: (First & Last Name and Date of birth)

What language does your family primarily speak?(Required)

How did you hear about us?

A Head Start parent

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