Contact Form
  • Please fill out the following form if you would like to be contacted by Pocatello/Chubbuck SD#25 Head Start for an application appointment for your child. 
     
  • You will then be directed to a page listing the items you must bring with you to your appointment and a map to help you find us. 

THIS CONTACT FORM IS NOT THE APPLICATION FORM! 
You must make an appointment to come in and complete the application with a family services staff member.
  * required information

Please provide the following contact information:

Parent/Guardian Name*
Street Address
City
State
Zip/Postal Code
Home or Cell Phone*  
Msg. Phone*  
E-mail Address

Please provide your child's information

Child's First & Last Name*
Child's Date of Birth* (MM/DD/YYYY)

Preferred communication method and/or questions*:


Pocatello/Chubbuck School District #25 Head Start
Copyright © 2011 Pocatello/Chubbuck School District #25 Head Start. All rights reserved.
Revised: March 08, 2012