This is a pre-application for our program. Please fill out each field and answer the questions to the best of your ability. Once we have processed the pre-application we will schedule an appointment for you to come into our office for an intake to verify your income and determine eligibility.
Name of primary parent or guardian
Please put in your living address, and mailing address, if different. If homeless, please put 'homeless' on the "Living address (required)" line.
Click here to find a provider in your area.

Are there other adults in the household?

Add Another Adult
Please fill this section out for the child or pregnant mother applying.
- Your Address - Available Locations
Click a location on the map to see more info
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
Please review all answers for accuracy before submitting. If you have any questions or do not hear from us within 2 weeks, we can be reached at 541-673-6306.
Required information is missing, see above.