About Fifth Ward Elementary Head Start
1.) A copy of an original birth certificate
2.) Proof of residency (You will need to bring two pieces of documentation to document legal residency)
____ Act of Sale/Mortgage for home or lease agreement/rental contract on company letter head
____ Voter’s Registration Card (Showing name and addess)
____ Electric bill
____ Tax Assessor’s Bill
3.) A copy of court record to verify legal guardianship, if applicable
4.) A copy of student’s social security card
5.) A copy of your child’s immunization records
West Bank Site--St. James Parish Health Unit – Friday 8 AM-10: 30 AM by appointment only
6.) Proof of income
____Two (2) consecutive check stubs for EACH PARENT or CAREGIVER IN THE HOUSEHOLD for
the current year (within 2 months from the date filling out this application).
____An official letter from your employer stating all of the following:
Where parent/guardian is employed, hourly rate of pay, the average number of hours a parent/guardian works per week.
____Snap /Food Stamps-must include the child’s name and valid effective dates.
____A statement from the Social Security Administration verifying that the child listed on the
application is a recipient of SSI benefits, which must be accompanied by two current check
____Current foster care placement agreement from DCFS
____Families who claim zero income of any kind must submit a Statement of No Income form.
____Parents or guardians who are employed intermittently, self-employed, or who do not have tax
forms, W-2 forms, check stubs, or applicable DCFS printouts to verify their income must submit a
Declaration of Income for Irregular Employment form.
____ Families in temporary living arrangement due to loss of housing or economic hardship ( homeless).
Community Network should follow LEA-defined procedures for verifying homeless status.
(May be subject to review. Note: 2018 tax documentation is allowable only if no other form of income
verification documentation exists. Previous tax years are not allowed.)
7.) Copy of Parent ‘s Louisiana Driver’s license or State –issued ID Card
Fifth Ward Elementary Head Start Community Questionnaire
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