Please fill out the following questions as completely as possible and considering your family's current situation.
Note: This application is for home-based services ONLY.
Are there other adults in the household?
Do you want to apply now for another child in your family?
Are there other children in the family?
Thank you for your application, we will be contacting you to schedule a visit to verify this information. Please make sure you have proof of income ready. If you have not heard from us within 2 weeks please call us at 435.673.5353 ext 164.
Please click submit to finalize your application.