2020-2021 Membership Application
RequiredRequired Question(s)

Membership Dues Schedule:

Agency Membership
Agency HS/EHS and or Early Head Start Budget
R9HSA Annual Dues 2020-2021
0-$1 million
$1.1 - $6 million
$6.1 - $15 million
$15.1 - $25 million
$25.1 - $40 million
$40.1 - $60 million
$60 million +

Corporate Membership
Corporations and other allied organizations are welcome to join the R9HSA as Corporate Members. The annual fee is $500.00. Depending on the nature of the product or service, The Corporate Member will be listed as one of our Training Partners or as a Service & Resource.

Friends Membership
Friends of the R9HSA are individuals who value the work of the association. Friend Membership allows you to hold an individual membership and would include all member benefits including registration discounts, participation on our Board of Directors and advisory groups. The annual fee is $250.00.

Current membership is active when payment is received; please submit payment to: 
Region 9 Head Start Association
2131 Capitol Avenue, Suite 307
Sacramento, CA 95816

Indicate your Membership Type

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

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

50 characters left.
Agency Director/ Corporation Representative Information: 

First Name:
Last Name:
Job Title:
Work Phone:
Email Address:
Address 1:
Address 2:
Postal Code:


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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Grantee Number (If Corporate Membership, please skip)


50 characters left.

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

New member

Are you a new Head Start program? 


How long have you been a grantee? 

1-3 years
3-6 years
6+ years
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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.  

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? 

  • Comment:

  • 500 characters left.

Does your program participate in Dollar per Child? 


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

  • Comment:

  • 500 characters left.

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.