wdhs@westerndairyland.org
Apply Now

Child's Name

Parent/Guardian

Male

Female

Street 1

Street 2

City

Zip

County

Home Phone

Or leave a message at:

Email

Day Care Currently Attending

School District Child Resides In

Child's Birth Date

Age as of Sept. 1st

Parent's Birth Date

 

Number of People Living in Your Household:

Adults

Children

Person Preparing Form

Date


 

How to Apply for Head Start

Call or Write to:

Call (715) 985-2391 ext 252
or 1-800-782-1063 ext 252 with the information
or mail this application (PDF) .

In Person:

Take this application (PDF) with income and age documents to a Head Start Center or the central office at
Western Dairyland
23140 Whitehall Road
Independence, WI

 

Home Locations Calendar ResourcesApply Now
 

Main Office
23122 Whitehall Road
PO Box 125
Independence, WI 54747
715-985-2391 ext 252
1-800-782-1063 ext 252

Eau Claire Office
418 Wisconsin Street
PO Box 540
Eau Claire, WI 54702
(715) 836-7511 ext 115

Wisconsin Headstart Association