Riverbend Head Start & Family Services

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Refer a Client

Do you know someone who is parent or has a baby or toddler?
Is the person interested in preschool at no cost to his/her family?

Madison County, Illinois families with a child ages birth through five qualify for our Head Start and Early Head Start if they are living at 100% of the Federal Poverty Level, have a child with a disability or are involved with the Department of Children and Family Services. We also enroll pregnant mothers.

We can help you create the best foundation for children and families. Just submit this form and we'll get back to you or contact the family right away.

The information you submit will be kept confidential.

Parent Information

About the Client or Family

Age of parent(s) (check as many as apply)

Under 18 18-25 25-35 35+

Age of child(ren) under 6 years old (check as many as apply)

Pregnant Mom <1 1 2 3 4 5

If you have a specific program of Riverbend Head Start & Family Services in mind, which one is it?

Head Start
Early Head Start

The client or family needs: (check as many as apply)

Positive case management
Preschool

Contact Information
Contact Me (above information)
Contact the Family

    Parent Name:

    Phone Number:

    Address:

    City:

    State:

    Zip Code:

    Email:

May we tell them you made the referral?

Yes
No

Is there anything else that you would like us to know?


If you prefer to make the referral over the phone, call (618) 463-5946.

Thank you for the referral. We appreciate your confidence in our ability to strengthen families. We will contact them soon.