2019-2020 Membership Application
RequiredRequired Question(s)

Membership Dues Schedule:


Agency HS/EHS and or Early Head Start Budget
 R9HSA Annual Dues 2019-2020
0-$1 million
 $250.00
$1.1 - $6 million
 $500.00
$6.1 - $15 million
 $750.00
$15.1 - $25 million
 $1,000.00
$25.1 - $40 million
 $1,250.00
$40.1 - $60 million
 $1,500.00
$60 million +
 $1,750.00

___________________________________________________
Current membership is active when payment is received; please submit payment to
Region 9 Head Start Association
1225 8th Street, Suite 342
Sacramento, CA 95814
___________________________________________________
 
Required

Indicate your Membership Type

Head Start or Early Head Start, Child Care Partner Agency Membership
Corporate or Friend Membership
  • Comment:

  • 500 characters left.
Required
Full Legal Name of Agency/Organization
 

50 characters left.
Required
Agency Director/ Corporation Representative Information: 


First Name:
Last Name:
Job Title:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required

Indicate your Agency/ Organization Type

School District
Operated by the County Office of Education
Private Non-profit
Head Start Agency
Other (please indicate below)
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  • 500 characters left.

Grantee Number (If Corporate Membership, please skip)

 

50 characters left.
Required

Are you renewing your membership or are you a new member to Region 9 Head Start Association? 


New member
Renewing
Required

Are you a new Head Start program? 

yes
no
Required

How long have you been a grantee? 

1-3 years
3-6 years
6+ years
  • Comment:

  • 500 characters left.

Indicate Total Enrollment (If Corporate Membership, please skip)

 

50 characters left.
Region 9 is a vast and diverse area of the nation and we strongly value an understanding of our region.  Please answer the following questions to the best of your ability, as they serve to help inform us.  
 
Required

Does your program experience difficulty accessing professional development and training resources? If so, please elaborate. 


 

350 characters left.

Are you familiar with Dollar per Child? 

Yes
No
  • Comment:

  • 500 characters left.

Does your program participate in Dollar per Child? 

Yes
No

Are you interested in learning more about Dollar per Child and how to get involved? 

Yes
No
  • Comment:

  • 500 characters left.
Required

How valuable do you find each of the following attributes of our membership? 

 Not very valuable    Very valuable 
Annual Scholarships
Access to research and current Head Start news
Professional Development Conferences in my own state
Professional Development Conferences in an adjacent state within my Region
Discounts to events
Website content
Learning about effective strategies used in other programs across the region
  • Comment:

  • 500 characters left.
What can we do better? We appreciate your feedback. 
 

1000 characters left.