Apply Now

Apply Now

Take advantage of our online applications. Many of our programs offer pre-application, application, and registration for programs online when possible. Below are our online forms. Click on the tabs below for more information.

Head Start

For your convenience, we provide the Head Start application packet online. Bring in all required documentation along with a completed Head Start application to your caseworker during your scheduled appointment.

Head Start Application Form (English) One application per household; new applicants only!

Head Start Formulario de Solicitud (en espaƱol)

Utility Assistance

To apply for utility assistance all applicants must pre-apply through the State of Mississippi’s data collection program, Virtual ROMA. After pre-applying, applicants can meet with our case workers to continue the application process.

State of Mississippi’s Virtual Roma System

Families First

Families First for Mississippi Registration

Please complete all fields of this form and our staff will get back to you shortly with more information.


Volunteer Information Form

Jackson County Civic Action Committee, Inc. is always in need of volunteers. Complete our form to get more information and partner with us in community works.
  • Applicant Information

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  • The following information is for demographic purposes only.
  • Work Information

  • Interests