Apply Online

Application for Program Year 2026-2027

Congratulations! You are taking the first step towards your child's successful future.

Enrollment is based on need, we are not a first come, first served program.
The information you provide to us will only be used to determine your child’s eligibility for services and will be kept confidential.
Proof of income is required to determine eligibility and is part of the application process.
Completing this application does not guarantee placement.

FOR NEW FAMILIES ONLY

You do not need to fill this out if you have an application with us already.
If you have any questions or want help filling out the application, please call us & ask for enrollment:
608-299-1500 or 1-800-774-7778 Fax: 608-299-1629
E-Mail: bobrien@cfsheadstart.org or nmarx@cfsheadstart.org

Si necesita esta aplicación en español, por favor haga clic aquí

*RWCFS does not discriminate on the basis of race, sex, age, color, national origin, religion, or disabilities in the provision of services & employment.*

This section should be completed by the person caring for the applicant child and is either the biological parent by blood, marriage, adoption, legal guardian or foster parent.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone (Required)

Home Phone (Required)

Work Phone (Required)

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed (Required)

Employment Status

Child's Relationship (Required)

Custody

Provides Financial Support

Teen Parent

If Teen Parent, Subsidized?

Please complete this section and keep us updated on any changes by contacting the enrollment office: 608-299-1500

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

This section is for information on the secondary biological parent by either blood, marriage, or adoption, the legal guardian or the foster parent.
Absent parents can be listed here with as much information as you have for them.
Please, do not list boyfriends/girlfriends as legal step parents, there is a separate section for other adults in the household.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Email Address

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Lives with Family

English Proficiency

Other Language

Highest Grade Completed (Required)

Employment Status

Child's Relationship (Required)

Custody

Provides Financial Support (Required)

Teen Parent

If Teen Parent, Subsidized?

Are there other adults in the household?

Add Another Adult

Please fill out this section completely .

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Household

Number in Family

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

Add Emergency Contact

Please answer all questions.

First Name (Required)

Middle Name

Last Name (Required)

Birthday (Required)

Gender

Race and/or Ethnicity - To specify multiracial and/or multiethnic please check all races and/or ethnicities that apply

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Middle Eastern or North African

Native Hawaiian or Pacific Islander

White

Prefer not to answer

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage (Required)

Other Coverage

Doctor/Medical Home (Required)

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development? (Required)

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

PLEASE READ THE STATEMENTS BELOW CAREFULLY BEFORE SUBMITTING

For enrollment purposes, I understand that RWCFS Head Start-Early Head Start may need to coordinate programming with my local school district, WI Shot Registry, and/or day care provider for transportation, placement, 4K/P4J registration, scheduling, and other home visitation programs.
By submitting, I verify that I am the parent/legal guardian of this child and that the information provided is correct and complete to the best of my knowledge. I further understand that if I knowingly provide false information that my family may no longer be eligible for further services.

REMEMBER, AN INCOMPLETE APPLICATION WILL DELAY PROCESSING-SEE INTRODUCTORY INSTRUCTIONS FOR DETAILS

Required information is missing, see above.

Application for Program Year 2026-2027

Congratulations! You are taking the first step towards your child's successful future.

FOR NEW FAMILIES ONLY

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings

PLEASE READ THE STATEMENTS BELOW CAREFULLY BEFORE SUBMITTING

REMEMBER, AN INCOMPLETE APPLICATION WILL DELAY PROCESSING-SEE INTRODUCTORY INSTRUCTIONS FOR DETAILS

Application for Program Year 2026-2027

Congratulations! You are taking the first step towards your child's successful future.

**FOR NEW FAMILIES ONLY**

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Emergency Contacts

Child (Applicant)

Location Preferences

Additional Applicant

Siblings

PLEASE READ THE STATEMENTS BELOW CAREFULLY BEFORE SUBMITTING

REMEMBER, AN INCOMPLETE APPLICATION WILL DELAY PROCESSING-SEE INTRODUCTORY INSTRUCTIONS FOR DETAILS

FOR NEW FAMILIES ONLY