Over the phone or in-person interview will be required prior to processing application.
Please answer all questions about education, employment and income based on the date of the application. For teen parents, only enter yes if 19 years or younger on the date of application.
The term "homeless” means individuals who lack a fixed, regular, and adequate nighttime residence. Children and youths who are sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations; are living in emergency or transitional shelters; or are abandoned in hospitals. Children and youths who have a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings. Children and youths who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings.
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Only complete this section if the secondary adult is currently living in the home, being supported by the same income and related blood marriage or adoption.

Are there other adults in the household?

Add Another Adult
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
If your child has an IEP or IFSP in place, please place the diagnosis along with services begin and end dates in the notes section below
- Your Address - Available Locations
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Do you want to apply now for another child in your family?

Add Another Applicant
Once application and interview has been completed, your child's application will be reviewed by the selection committee. You will be notified of application status via phone/letter and email.
Required information is missing, see above.