Income and age verification will determine your child's eligibility for acceptance and enrollment. We also serve pregnant moms!
Please complete all fields of this form and our staff will get back to you shortly with more information.
Once the application has been initiated it must be completed and submitted! The application will not save!
Primary Adult is the individual related to the child applicant by blood or marriage; it may also be the legal guardian or social worker who presents legal documents verifying their status.
Living address is where the family resides
(must be within the boundaries of Jackson County).
Mailing address is where the family wants their mail to be sent.
Secondary Adult is the other adult family member related to the child applicant by blood or marriage and provides support to the family.
Are there other adults in the household?
Family is defined as "all persons living in the same household who are supported by the child's parent(s)' or guardian(s)' by blood, marriage, or adoption; or the child's authorized care giver or legally responsible individual.
Child (Applicant) is the infant, toddler or child (excluding an unborn child) for whom this application is being processed.
Do you want to apply now for another child in your family?
Are there other children in the family?