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​​​​​​For Community Agencies & Health Clinics Only

To Participating Agencies:

Please use this form for any child that you are referring to Head Start/Early Head Start. Fax the completed form, with a fax cover page to (209) 381-5172, or email​ to 

Staff will be contacting the family, using the contact information listed below, within the next two weeks.

If you have any questions as to the status of this referral, please contact the Family Support Services Manager at (209) 381-5170.


Head Start Referral Form

Head Start Referral Form


Head Start Program

​​1840 Wardrobe Ave, Merced, CA 95341
(209) 381-5170