The following is an Interest form for Early Learning Indiana Childcare.
Parent/Guardian
Complete this information about the Child's primary care giver.
First Name (Required)
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
Opt In for Text Messages
Yes
No
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
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Burmese
Chinese
English
French
Fulani
Haitian Creole
Igbo
Japanese
Mandingo
Mongolian
Nepali
Spanish
Swahili
Twi
Uruba
Yoruba
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
Is your family experiencing homelessness?
Yes
No
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
Additional Parent/Guardian
Complete if married and both parents are living in the same home.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
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
Opt In for Text Messages
Yes
No
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
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Burmese
Chinese
English
French
Fulani
Haitian Creole
Igbo
Japanese
Mandingo
Mongolian
Nepali
Spanish
Swahili
Twi
Uruba
Yoruba
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Family Information
For TANF, SSI, WIC or SNAP only answer 'Yes' if you are currently receiving those benefits. Proof of Income and copies of awards letters will be requested.
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
American Sign Language
Arabic
Burmese
Chinese
English
French
Fulani
Haitian Creole
Igbo
Japanese
Mandingo
Mongolian
Nepali
Spanish
Swahili
Twi
Uruba
Yoruba
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic/Latino
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
American Sign Language
Arabic
Burmese
Chinese
English
French
Fulani
Haitian Creole
Igbo
Japanese
Mandingo
Mongolian
Nepali
Spanish
Swahili
Twi
Uruba
Yoruba
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Doctor/Medical Home
Action Health Center
Adult and Child Health
Allergy Partners
Amanda Beach
Ascension Medical Group
Autumn Sauer NP
BABE program
Barrington Health and Dental Cen
Beth Adkins
Central Indiana First Steps
CHN- Family Med, Peds, OB
Community Health Network
Community Health Pavilion Ft.Ben
Community Health Pavilion Speedw
Community Health Pavilion-Saxony
Community Health Pediatric Care
Community Pavilion Washington
Community-Family & Internal Med
CommunityNetworkFamilyMedicine
Damar Services Inc.
Danville Pediactrics
Downtown Pregnancy Center
Dr Diana Burtea
Dr. Abigail Haste
Dr. Alicia Leedy
Dr. Allie Sadowitz
Dr. Amanda Walter
Dr. Ann Wojtalik
Dr. Anne Clark
Dr. Anne Kelly
Dr. Anne Ogren
Dr. Ashleigh Galizio
Dr. Ashlie Stallion
Dr. Audrey Wehr
Dr. Baron Kidd
Dr. Beth Barron
Dr. Beth Buchanan
Dr. Bethany Troutwine
Dr. Billie Jameson
Dr. Bradey Kleman
Dr. Brian Benjamin
Dr. Brittany Maloney
Dr. Bryan Berman
Dr. Carol Johnson
Dr. Carrie Leathers
Dr. Carter
Dr. Chehab
Dr. Cheri Cruz
Dr. Cheryl Ferguson
Dr. Cho
Dr. Christen Prible
Dr. Christina Fox
Dr. Coleman
Dr. Council
Dr. Craig Mueller, DDS
Dr. Cynthia Countryman
Dr. Cynthia Meneghini
Dr. Cynthia Reed
Dr. Dan Dusleag
Dr. Dana Hiller
Dr. Daniel Guiles
Dr. Daniel Hayford
Dr. Daniel Linfesty
Dr. Danielle Erney
Dr. David Fryman
Dr. David Hoffman
Dr. David Porter
Dr. David Schwartz
Dr. David Van Reken
Dr. Dayna Ridderman
Dr. Deanna Reinoso
Dr. Diana Morales Zelaya
Dr. Dianna Fox
Dr. Dipti Vyas
Dr. Elise LaRoche
Dr. Ellen Fan
Dr. Emily Sherer
Dr. Eric Yancy
Dr. Erica Huddleston
Dr. Erin Burns
Dr. Erin Phipps
Dr. Erin Phipps
Dr. Eugene Justus
Dr. Evan Kreutzer
Dr. Evans Machogu
Dr. Frances Gray
Dr. Frank Tran
Dr. Freshteh Farahan
Dr. Garcia
Dr. Garcia
Dr. Gary Halberstadt
Dr. George Salfity
Dr. Gina Rivera Zelaya
Dr. Henry Jones
Dr. Hillard
Dr. Hilma Green
Dr. Ira Means
Dr. James Blackwell
Dr. James Leland
Dr. Janice Kunkel
Dr. Jared Snyder
Dr. Jeffrey Meglin
Dr. Jenna Walls
Dr. Jennifer Seele
Dr. Jennifer Walker
Dr. Jeremy Roscoe
Dr. Jeremy Rushton
Dr. Jessica Fortunak
Dr. Jill Helphinstine
Dr. Jim Megremis
Dr. Joan Doak
Dr. Joe Hannah
Dr. John Beerbower
Dr. John Kunzer
Dr. Jolene Fredriksz
Dr. Jonathon Evans
Dr. Jonathon Evans
Dr. Juan Carlos Venis
Dr. Katharina Weber
Dr. Katherine Crawford
Dr. Katherine Soe
Dr. Katherine Voges
Dr. Kathryn Johnston
Dr. Kathryn Kasyjanski
Dr. Kathy Cohenour
Dr. Kellie Hughes
Dr. Kelly Bean
Dr. Kerry Herdt
Dr. Kimberly Franklin
Dr. Kirsten Rubin
Dr. Kristin Hem
Dr. Kyle Speakman
Dr. Lara Darling
Dr. Laura B Calili
Dr. Laura Manzanilla Luberti
Dr. Laura Price
Dr. Lee Anne Osborn
Dr. Linda Blanchard
Dr. Linda DeCesare
Dr. Lindeman
Dr. Lindeman
Dr. Lisa Altuglu
Dr. Lourdes Heumann Geise
Dr. Mallery Neff
Dr. Margaret Feemster
Dr. Margarita Marlin
Dr. Maria Herrera
Dr. Marly Bradley
Dr. Mary Hodson
Dr. Mary Jo Stine
Dr. Matthew Overley
Dr. Matthew Wolf
Dr. Meagan O'Neill
Dr. Meaghan Keller
Dr. Megan Gruesser
Dr. Michael McKenna
Dr. Michael Summers
Dr. Michael Wilson
Dr. Michelle Timmons
Dr. Mitchell Harris
Dr. Mualla Akisik
Dr. Mushkbar Khan
Dr. Nathan Roth
Dr. Nayan Srivastava
Dr. Nicole Nace
Dr. O'Brien
Dr. Patricia Treadwell
Dr. Paul Haste
Dr. Philip Blaney
Dr. Racheal Meadows
Dr. Rafi
Dr. Rebecca Lindberg
Dr. Richard Bernhardt
Dr. Rinderknecht
Dr. Risa Davidson
Dr. Robert Gonzalez
Dr. Robert Lindeman
Dr. Ryan Grimm
Dr. Ryan Stegink
Dr. Ryan Venis
Dr. Sarah Cook
Dr. Sarah Cook-Longmire
Dr. Sarah Gangadhar
Dr. Sarah Hill Schaffer
Dr. Sarah Palmer
Dr. Saura Fortin Erazo
Dr. Shana Zwick
Dr. Shanna Bowman
Dr. Shannon Tighe
Dr. Shivika Jain
Dr. Sommer Rentmeesters
Dr. Stefanie Smith
Dr. Sunita Premkumar
Dr. Tamara Dickerson
Dr. Tamara Dickerson
Dr. Tamra Dickerson
Dr. Tanya Wilson
Dr. Teri Schulz
Dr. Thomas Klausmeier
Dr. Timothy Eisenhut
Dr. Tokunbo A Osuntokun
Dr. Toya Corbitt
Dr. Urmila Singh
Dr. Valerie Pai
Dr. Varon Cantrell
Dr. Ward Polous
Dr. Willer
Dr. William Fisher
Dr. William Greenwood
Dr. Young Hughes
Elissa Jones-Hua NP
Eskenazi Advantage
Eskenazi Cottage Corner
Eskenazi Grassy Creek Health Cen
Eskenazi Health Blackburn
Eskenazi Health Center N Arlingt
Eskenazi Health Center Pecar
Eskenazi Health Center Pediatric
Eskenazi Health Forest Manor
Eskenazi Health Midtown
Eskenazi Health West 38th
Eskenazi West
First Steps of Central IN
Franciscan Health Family Medicin
FranciscanPhysician-Franklin Twn
Franciscianphysician-Network
Gennesaret Outreach Clinic
Health Net Advantage
Health Net Northeast
Health Net Pediatric Clinic
Health Net West
HealthNet at the Tower
Healthy Families / HealthNet
Healthy Indiana Plan
Hear Indiana
Heartland Crossing Pediatrics
Hendrick's Regional Health
Hispanic Children's Doctors
Idella Simmons Family Medicine
Indiana Adult & Pediatric
Indiana Dental Academy
Indiana Immunization Coalition
Indianapolis Dental Assistant Sc
Indianapolis FSSA
IU Audiology & Speech
IU Georgetown Medical
IU Health North Hospital
IU Health Physician Primary Care
IU Health Physicians Primary Car
IU Health- Avon
IU Health- Behavioral Health
IU Health- East Washington
IU Pediatric Opthalmology
IU School of Optometry
IU/Methodist Family Medicine Cen
IUH Health- Anson
Jamie Pinter, CNM
Jane Pauley Arlington Ave Peds
Jane Pauley Community Health ctr
Jane Pauley Health Center
Jane Pauley- 16th street
Jane Pauly Health Center
JoAnn Morris MN, FNP
Johnson Memorial Health-Peds
Juanita Clower, PNP
Kaylee Morrow
Kids'Health.org
Laura Sulecki
Lindsey Shine
Lion's Club
Magnificat Family Medicine
Marion County Health Dept
Marion County WIC
Martindale Brightwood Health cen
MCPHD-Lead Screening
MDWise Hoosier Alliance
Megan Ciacccio, MD
Meghan Rowland Boyls NP
Melissa Redden, NP
Mercy Moto, NP
Methodist Medical Tower
Methodist Medical Towers
Midwest Eye: Insight Optical
Milk Bank
Moorseville Family Care
Northeast Health Center
Northpoint Pediatrics
Nurse Family Partnership
Ossip Optometry
Otolaryngology Associates
Patrick Mullins
Pediatric and Adolescent Care
Peoples Health Center
Peyton Manning Children's Peds
Plainfield Family Medicine
Purdue Ext. Marion County
Raphael Health Center
Riley Hospital ENT
Riley Hospital for Children
Riley Hospital General Pediatric
Riley Physician Pediatrics
Riley Physicians Pediatrics
Riley Physicians Pediatrics- IU
Riley Physicians pediatrics-IU
Riley Physicians Peds. Carmel
Riley Physicians Primary Care
Riviera Pediatrics
Sandra Eskenazi Outpatient
Shalom Health Care Center
Southeast Health Center
Southpointe Pediatrics
Southwest Health Center
St Francis Physicians
St Vincent De Paul
St Vincent Olive Branch
St. Vincent Brownsbug Pediatrics
St. Vincent JMS Primary Care
St. Vincent Peds Clinic
St. Vincent- Westfield
St. Vincents primary Care Center
Stafford Pointe Family Physician
Trina Eastin
Whisper Hearing Center
Dental Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Dentist/Dental Home
Amazing Family Dental
Associates In Family Dentistry
Autumn Sauer NP
Barrington Health and Dental Cen
Brookside Dental Care
Caring Smiles 4U
ClarkDean&Assoc ChildDentistry
Community Health Network
Community Health Pavilion Ft.Ben
Community Health Pediatric Care
Community Pavilion Washington
Community South Health Network
Community-Family & Internal Med
Cool Smiles
Czarkowski Pediatric Dentist
Czarkowski Pediatric Dentistry
Decatur Family Dentistry
Dental Resources
Dental Solutions of Avon
Destiny Dental
Detail Dental Kids
Devington Dental Office
Dr. Allie Sadowitz
Dr. Ann Wojtalik
Dr. Anne Ogren
Dr. Annette Farthing
Dr. Carol Johnson
Dr. Cheri Cruz
Dr. Cheryl Ferguson
Dr. Christina Fox
Dr. Craig Mueller, DDS
Dr. Cynthia Countryman
Dr. Dan Dusleag
Dr. Daniel Linfesty
Dr. David Fryman
Dr. David Porter
Dr. Dayna Ridderman
Dr. Deanna Reinoso
Dr. Diana Morales Zelaya
Dr. Dianna Fox
Dr. Eric Yancy
Dr. Erin Phipps
Dr. Evan Kreutzer
Dr. Freshteh Farahan
Dr. Garcia
Dr. Janice Kunkel
Dr. Jennifer Walker
Dr. Jill Aldrich
Dr. Jim Megremis
Dr. Joan Doak
Dr. Jolene Fredriksz
Dr. Katherine Soe
Dr. Kathy Cohenour
Dr. Kelli Lucia-Ijams
Dr. Kelly Bean
Dr. Kelly Hinds
Dr. Kimberly Franklin
Dr. Kirsten Rubin
Dr. Kristin Hem
Dr. Lara Darling
Dr. Laura Price
Dr. Linda Blanchard
Dr. Linda DeCesare
Dr. Lindeman
Dr. Mallery Neff
Dr. Margarita Marlin
Dr. Maria Herrera
Dr. Mark Kahn, DDS
Dr. Mary Hodson
Dr. Mary Jo Stine
Dr. Megan Gruesser
Dr. Merneatha Baizilio
Dr. Michael Davis
Dr. Michael Rice
Dr. Michael Wilson
Dr. Nayan Srivastava
Dr. Nicole Nace
Dr. Nicole Weddell
Dr. Paul Haste
Dr. Racheal Meadows
Dr. Rinderknecht
Dr. Risa Davidson
Dr. Robert Gonzalez
Dr. Ryan Grimm
Dr. Ryan Stegink
Dr. Ryan Venis
Dr. Sarah Gangadhar
Dr. Scott Papineau, DDS
Dr. Shanna Bowman
Dr. Shannon Tighe
Dr. Tamra Dickerson
Dr. Teri Schulz
Dr. Thomas Klausmeier
Dr. Timothy Eisenhut
Dr. Tokunbo A Osuntokun
Dr. Toya Corbitt
Dr. Valerie Pai
Dr. Willer
Dr. William Greenwood
Dr. Young Hughes
Eagle Creek Dentistry
Ellis Pediatric Dentistry
Eskenazi Cottage Corner
Eskenazi Grassy Creek Health Cen
Eskenazi Health Blackburn
Eskenazi Health Center North Arl
Eskenazi Health Forest Manor
Eskenazi Health West 38th
Eskenazi Pecar-Dental
Eskenazi West
Familia Dental 38th Street
Familia Dental Group
Fishers Pediatric Dentistry
Forest Manor Dental Clinic
Frazee Family Dentistry
Gennesaret Outreach Clinic
Gentle Dentist- Dr Awad
Georgetown Dental Center
Health Net Pediatric Clinic
Health Net West
HealthNet Meadows
HealthNet NorthEast
Heartland Crossing
Hendricks Pediatric Dentistry
Hispanic Children's Doctors
IU Health North Hospital
IU School- Dental Clinic
Jane Pauley Arlington Ave Peds
Jane Pauley Community Health ctr
Juanita Clower, PNP
Keystone Family Dental
Kids Dentistree- Avon
Kool smiles 38th street
Kool Smiles-East
Kool Smiles-Keystone
Litz Kidz Dental
Meghan Rowland Boyls NP
Melissa Redden, NP
Meridian Dental Center
Meridian Dental Center
Methodist Medical Towers
Mitthoefer Family Dental
Newman Family Dentistry
Northpoint Pediatrics
Parkway Dental Care
Pediatric and Adolescent Care
Pediatric Dentistry North
Pediatric Dentisty West
Peoples Health Center
Pippin Dental
Prime Smiles
Prime Smiles East
Prime Smiles East
Raphael Health Center
Riley Dental Clinic
Riley Hospital General Pediatric
Riley Physicians Pediatrics
Riley Physicians Peds. Carmel
Riviera Pediatrics
Sandra Eskenazi Outpatient
Seal Indiana
Shalom Health Care Center
Sinnis Family Dental
Small Smiles
Smiling Kids Dentistry
Smith-Brauer Dentistry
Sonrisa Dental
SouthEast Health Center
Southwest HealthNet Dental
St. Vincent Peds Clinic
St. Vincents Primary Care Center
Star Dental
Steele Pediatric Dentistry
Summerlih Family Dental
University Pediatric Dentistry
Weddell Pediatric Dentistry
West 10th Dental Group
West Side Family Dental
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Early Head Start Infants/Toddlers for 2022-2023
High Quality Child Care for Infants and Toddlers
1st Location Preference
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2nd Location Preference
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- Your Address
- Available Locations
Click a location on the map to see more info
Click here
to find a provider in your area.
Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Siblings
Are there other children in the family?
Add a Sibling
You will receive an email confirmation once the application is submitted. We will contact you within 14 days to schedule an appointment to complete the registration process. You are responsible for updating contact information if it changes. We will only use the numbers and addresses submitted to notify you of your child's status.
Required information is missing, see above.