Minnesota Head Start Heroes Awards Application

Submission Deadline: January 6, 2017

Applicant Information
Applicant Name / Click here to enter text.
Street / PO Box / Click here to enter text.
City / Click here to enter text.
Zip Code / Click here to enter text.
E-mail Address / Click here to enter text.
Phone Number / Click here to enter text.
# of Years in Head Start / Click here to enter text.
Program Information
Program Name / Click here to enter text.
Director / Click here to enter text.
Nominating Staff Member / Click here to enter text.
Mailing Address / Click here to enter text.
City / Click here to enter text.
Zip Code / Click here to enter text.
Contact E-mail Address / Click here to enter text.
Phone Number / Click here to enter text.

Application Category – check one

☐ / Category 1: Head Start alumni (parent/guardian or child) who has become involved in their local community through volunteerism, leadership, involvement in committees/councils/boards, cultural or linguistic contributions.
☐ / Category 2: Head Start family who has made significant life changes within the past 12 months and is currently enrolled in a Head Start or Early Head Start program or is serving on a Policy Council.
☐ / Category 3: A currently enrolled Head Start or Early Head Start child who has made tremendous developmental progress while enrolled in a Head Start / Early Head Start program.
☐ / Category 4: Head Start alumni (parent/guardian or child) who has gone on to an early childhood profession serving in a health, mental health, education, nutrition, disabilities, parent involvement/education, cultural competency or advocacy field.
☐ / MHSA has my permission to use my story with or without my name for any lawful purpose, including print and digital publications.

Application Instructions:

·  Please complete ONLY the essay for the category for which you are applying, save and return by e-mail to () by Friday, January 6, 2017.

·  Essays must be a minimum of 250 words, but no more than 650 words. All applications should be written in partnership between a parent / family member / alumni and the nominating staff member.

·  Be sure to complete the name and number of words blanks at the top of the essay page you are completing.

·  Applications must be for individuals. Group applications will not be accepted.

Due Date: January 6, 2017

All applications must be received by 4:30 pm.

Minnesota Head Start Heroes Awards Application Essay

Category 1: Alumni involved in their local community
Applicant Name / Click here to enter text. / Number of words in essay / Click here to enter text.
Tell us your compelling story – how did you get involved in Head Start, how has it empowered you to become involved in your local community, how has it lead to leadership, volunteerism, involvement in committees/councils/boards, provided cultural or linguistic contributions.
Click here to enter text.

Minnesota Head Start Heroes Awards Application Essay

Category 2: Family made significant life changes
Applicant Name / Click here to enter text. / Number of words in essay / Click here to enter text.
Tell us your compelling story – how did you get involved in Head Start, what significant life changes have you made, how has Head Start empowered you to make these changes?
Click here to enter text.

Minnesota Head Start Heroes Awards Application Essay

Category 3: Child made tremendous developmental growth
Applicant Name / Click here to enter text. / Number of words in essay / Click here to enter text.
Tell us your compelling story – how did you get involved in Head Start, how has your child grown while in their program, how has Head Start helped your child make these strides?
Click here to enter text.

Minnesota Head Start Heroes Awards Application Essay

Category 4: Alumni involved in an early childhood profession
Applicant Name / Click here to enter text. / Number of words in essay / Click here to enter text.
Tell us your compelling story – how were you involved in Head Start, what early childhood profession are you now involved in, how did the program empower you to go on to this profession?
Click here to enter text.