Please fill out the online application form completely & if you need help you can call us at (408) 453-6900 or (800) 820-8182, Monday - Friday, from 8:00 a.m. to 5:00 p.m.
Please make sure to fill out this section completely.
Click here to find a provider in your area.
Please complete this section if Secondary Parent is related by Blood, Marriage, Adoption or Foster.
If you receive any government aid such as TANF, Cash Aid, or SSI you are eligible for our services. If you do not receive government aid please add your annual gross income before taxes.
In child notes please include if your child has an active Individualized Educational Plan (IEP) or Individualized Family Service Plan (IFSP).
- Your Address - Available Locations
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Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling
Thank you for your interest in our ELS Program. Please click submit to proceed to the next step of our application process. We will contact you to set up an appointment to submit additional documentation.
Required information is missing, see above.