MC Headstart
  • Household Info
  • Family Info
  • Child's Info
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Mora/Colfax Head Start and Early Head Start
MISD Pre-K
P.O. Box 179, Mora, NM 87732
Phone: (575)-387-6486
Fax: (575) 387-3111
www.mora.k12.nm.us

School Year 2023-2024

Program Applying For: Check One

Head Start (Children 3-5 Years Old)
Early Head Start

CHILD APPLICANT OR PRENATAL MOM: Information about the child who is applying or the pregnant mom

Female/ Male
Race: (Check One)
Ethnicity: Hispanic
Does the Child/Pregnant Mom have a Disability?
Does the child have an IFSP/IEP
Is the child receiving special services for the disability?
Has the disability been professionally diagnosed?

Family Information

Living Address
Living Address
City
State/Province
Zip/Postal
Mailing Address
Mailing Address
City
State/Province
Zip/Postal
Address if different from above:
Address if different from above:
City
State/Province
Zip/Postal
Employment Status
Address if different from above
Address if different from above
City
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Employment Status
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