Complete a separate application for each child.

Enrollment Information

I am applying for my child to begin enrollment (check one):
Has your child been in care previously:
If yes, care was
I am:

If you are a student, what is your

Child Information

This child's parents are:
Annual Household Income Range (pick one):
Who has legal custody of this child? (check only one of the following options)
Does your child receive services from any other agency?:

Child's Mother / Co-Parent

Child's Father / Co-Parent