Welcome!  Thank you for your interest in Reach Dane! Reach Dane is a federally funded agency that provides Head Start and Early Head Start services for low income families in Dane and Green counties.  Reach Dane provides high quality early childhood services to children ages 0-5 through center-based and home-based programs.

Proof of income is required to determine eligibility for Head Start and Early Head Start and is a part of the application process.

Examples of acceptable income forms:

• A copy of your most recent Federal Tax return
• Most recent W-2 Tax Statements from all employers
• Paycheck stub from current employer
• SSI Documentation
• Unemployment Payment
• W-2 (Wisconsin Works) Paperwork
• Foster Care/Kinship Care Placement for the Enrolling Child
• SNAP (Food Share Benefits)

Please call us at 608-275-6740 if you have any questions or concerns!

 

Thank you for completing this application. It may take a little time to finish, so please allow 10-15 minutes to answer all questions. Your answers help us better serve your family.

Please enter your child's legal name exactly as it appears on their birth certificate.

Pregnancy & Prenatal Questions:

• If you are enrolling a child, answer these questions about the pregnancy with that child.
• If enrolling as a pregnant participant, answer these questions about your current pregnancy.

Pregnancy & Prenatal Questions:

• If you are enrolling a child, answer these questions about the pregnancy with that child.
• If enrolling as a pregnant participant, answer these questions about your current pregnancy.

If at current job less than one year or unemployed, list dates of employment for the last 12 months:

Note: If there is no second parent or guardian, skip and scroll to the next section - Other Household Income.

If at current job less than one year or unemployed, list dates of employment for the last 12 months:

Report all household income sources below. Include gross amounts before taxes and list the amount and how often it is received.

Income verification (please submit one of the following):

• A copy of your most recent Federal Tax return
• Most recent W-2 Tax Statements from all employers
• Paycheck stub from current employer
• SSI Documentation
• Unemployment Payment
• W-2 (Wisconsin Works) Paperwork
• Foster Care/Kinship Care Placement for the Enrolling Child
• SNAP (Food Share Benefits)
• If you are experiencing homelessness: please contact the enrollment department directly at 608-275-6740.

If needing assistance with documentation, please call us directly at 608-275-6740.

Photos or documents of income verification can be submitted using one of the methods below:

• Upload using the box below
• Fax: 608-275-6756 Attn: Enrollment
• Email: enrollment@reachdane.org
• Text Photos: 608-576-1135 or 608-400-1388
• Mailing address: Reach Dane (Attn: Enrollment), 2096 Red Arrow Trail, Madison, WI 53711
• Signed applications and income verification can also be dropped off at Reach Dane center locations.

If you receive Public Assistance, please complete the Release Authorization so we can verify your benefits with Dane County.

Please complete either the English or the Spanish version of the form that was emailed to you. Once you have completed and signed the form, please upload it here.

Early Head Start and Head Start acceptance is based on the income and needs of the family/child, not on a first-come, first-served basis.

“I certify that the answers provided on this form are accurate and complete to the best of my knowledge. I understand that providing false information to a Federally-Funded Program is against the law. I am this child’s parent/guardian and this is our family’s income.”

Reach Dane/Reach Green is a non-profit corporation.  It does not discriminate in the administration of its programs.