Welcome to CNE! We are thrilled that you are interested in enrolling your child in one of CNE's programs. Please complete the full application. Some items are marked required, but please be sure you complete ALL fields, not just the ones marked required. Once you complete the application, you will be contacted by an Intake Specialist from CNE to coordinate gathering the required supporting documents for your application.
Parent/Guardian
Please complete all information for the primary parent.
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Email Address (Required)
Confirm Email Address
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African-Suahili, Wolof
American Sign Language
Caribbean -Haitian-Creole, Patois
East Asian-Chinese,Vietnamese,Tagalog
English
European/Slavic-German French Italian Croatina Serbian Yiddish Portuguese Russian
Middle Eastern -Arabic,Hebrew,Hindu,,Urdu,Bengali
Mixteco, Quicheana, Quetchua, Native Ctr.Am, S.Am, Mexican -
Native North American/Alaskan Native
Pacific Island-Palauan, Fijian
Spanish
Unespecified
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Address
Please enter your primary address. Please note that if you do not live in Evanston, Skokie, Morton Grove, Lincolnwood, Northfield, Northbrook, Wilmette or Winnetka you will be prohibited from completing the application. If that is the case for you, please contact CNE directly at cne@childcarenetworkofevanston.org.
Is your family experiencing homelessness?
Yes
No
Living Address (Required)
Address Line 2
City (Required)
State (Required)
ZIP (Required)
Click here
to find a provider in your area.
Mailing Address same as Living Address
Mailing Address
Address Line 2
City
State
ZIP
Additional Parent/Guardian
If there is a second parent (or guardian) in the home, please complete the information below. Please do not complete this section for any adults other than a second parent / guardian.
Is there another parent/guardian in the family?
Yes
No
First Name (Required)
Middle Name
Last Name (Required)
Birthday (Required)
Gender
Female
Male
Mobile Phone
Opt In for Text Messages
Yes
No
Home Phone
Work Phone
Ext.
It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African-Suahili, Wolof
American Sign Language
Caribbean -Haitian-Creole, Patois
East Asian-Chinese,Vietnamese,Tagalog
English
European/Slavic-German French Italian Croatina Serbian Yiddish Portuguese Russian
Middle Eastern -Arabic,Hebrew,Hindu,,Urdu,Bengali
Mixteco, Quicheana, Quetchua, Native Ctr.Am, S.Am, Mexican -
Native North American/Alaskan Native
Pacific Island-Palauan, Fijian
Spanish
Unespecified
Other Language Proficiency
Little
Moderate
None
Proficient
Highest Grade Completed
Associate's Degree
Bachelor's Degree
College Degree/Training Cert.
College or Advance Training
General Education Diploma
Grade 10
Grade 11
Grade 12
Grade 9 or less
High School Graduate
Master's Degree
Employment Status
Full-time & Training
Full-time (35 hours/week or more)
Part-time & Training
Part-time (Under 35 hours/week)
Retired or Disabled
Seasonally Employed
Training or School
Unemployed
Child's Relationship
Biological/Adopted/Step
Foster
Grandchild
Other
Other Relative
Custody
Yes
No
Lives with Family
Yes
No
Provides Financial Support
Yes
No
Teen Parent
Yes
No
Family Information
Number of Parents/Guardians
One Parent Family
Two Parent Family
Relationship to Participant(s)
Foster parent(s) not including relatives
Grandparent(s)
Other
Parent(s) (e.g. biological, adoptive, stepparents)
Relative(s) other than grandparents
Primary Language at Home
African-Suahili, Wolof
American Sign Language
Caribbean -Haitian-Creole, Patois
East Asian-Chinese,Vietnamese,Tagalog
English
European/Slavic-German French Italian Croatina Serbian Yiddish Portuguese Russian
Middle Eastern -Arabic,Hebrew,Hindu,,Urdu,Bengali
Mixteco, Quicheana, Quetchua, Native Ctr.Am, S.Am, Mexican -
Native North American/Alaskan Native
Pacific Island-Palauan, Fijian
Spanish
Unespecified
Number in Family
Gross Annual Income
Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?
Yes
No
Is your family receiving Supplemental Security Income (SSI)?
Yes
No
Is your family receiving services from WIC?
Yes
No
Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?
Yes
No
Is at least one parent/guardian an active duty member of the United States military?
Yes
No
Is at least one parent/guardian a veteran of the United States military?
Yes
No
Emergency Contacts
Add Emergency Contact
Child (Applicant)
First Name (Required)
Middle Name
Last Name (Required)
Suffix
Nickname
Birthday (Required)
Gender
Female
Male
Race
American Indian or Alaska Native
Asian
Black or African American
Multi-racial/Biracial
Native Hawaiian/Other Pacific Islander
Other
Unspecified
White
Hispanic
Yes
No
English Proficiency
Little
Moderate
None
Proficient
Other Language
African-Suahili, Wolof
American Sign Language
Caribbean -Haitian-Creole, Patois
East Asian-Chinese,Vietnamese,Tagalog
English
European/Slavic-German French Italian Croatina Serbian Yiddish Portuguese Russian
Middle Eastern -Arabic,Hebrew,Hindu,,Urdu,Bengali
Mixteco, Quicheana, Quetchua, Native Ctr.Am, S.Am, Mexican -
Native North American/Alaskan Native
Pacific Island-Palauan, Fijian
Spanish
Unespecified
Other Language Proficiency
Little
Moderate
None
Proficient
Primary Health Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Medicaid Eligibility
Not Eligible
On Medicaid
Potentially Eligible
Doctor/Medical Home
1st Family Dental & Midwest Orth
Academic General Pediatrics
Access at Sinai
Access Evanston Family Health
ACCESS Evanston-Rogers Park HC
Access Family Health Society
access genesis
Access to Care
ACMG
Advocate Children's Medical Grp.
Advocate Illinois Masonic
Advocate Medical Care
Advocate Medical Group Denistry
Advocate Medical Group Des Plain
Advocate Medical Group Park Ridg
AHS Family Health Center
Akinde, Kudas MD
allergy and asthma specialists
Amita Health Medical Group
Amita Health Medical Group
Anastasia Gianakakos, MD
Anna Bumphrey MD
Anna Kullk-Carlos
Antony, Sonia MD
Aronson, Adam MD
Asian Health Coalition
Asian Human Services
Asian Human Services
Asian Human Services
Askia Saunders
Atrium Health Wake Forest Baptis
Austin Health Center of Cook Cou
Austin Street Pediatrics
Belingon-Suerte, Cielo MD
Belmont Cragin Health Center
Belvidere Medical Clinic
Berestenko, Larissa MD SC
Bolton, Paul MD
Brighter Smile Dentistry, P.C.
Britt, Amanda MD
Caty Divincenzo
Chicago Area Pediatrics
Chicago Pediactric and Neo Cente
Chicago Pediatrics
Chicago Smile Specialists
Chicago Volunteer Doulas
Children's Hospital of Chicago
Children's Medicine P.C.
Children's Memorial Pediatrics
Christian Community Health Cente
Cimo, Sabrina MD
City of Chicago
Clara Arhigbe
colgate
Complete Dental Care
Crow, Aimee MD
cvs
Davis Mittleman md
Dental Matters
Dr Alvin, Baheti
Dr Campo
Dr Fatyga
Dr Kim
Dr Reza Ekhtera
Dr thomas
Dr. Dana
Dr. Gary Kaufman
Elm Street Pediatrics
Epic Urgent & Family Care
Erie - Lawrence & Kedzie
Erie Clinic
Erie Evanston/Skokie Health Cent
Erie Family Health Ctr-Evanston
Erie Foster Ave Health Center
Erie Humboldt Park Health Center
Erie Telehealth Health Center
Erie West Town Health Center
Evanston Civic Center
Evanston Hospital
Evanston Rodgers Park
evanston skokie school district
Eye vision ambulatory center
Family Care Glenview Health Cent
Family Dental of Lincoln
Family Doctors-Family Healthcare
family health center
Fiedler, Karin MD
First Family Dental of Pulaski
First Kids Pediatrics
Fitchev, Elena MD
Fox, Kenneth MD
Friend Family Health Center
Gabriela
Garfoli, Erin MD
Gavrilovici, Ana MD
Genesis Center for Health
George, Najat
Glenbrook Family Center
Glenbrook Northshore Hospital
Glencoe Pediatrics
Golf Mill Medical Center
Grace Pediatric
Hanna, Dima MD
Hartz, Barbara APN-CNP
Hayley Fernandez de Cordova
Healthy Babies Happy Families
Heartland Health Center - Devon
Heartland Health Center-Wilson
Heartland Health Centers - Lake
Heartland Health Centers - TP
Heartland Health Ctr-Rogers Park
Highland Park Pediatrics
Hill, Carl MD
Holy Family Medical Center
Howard Area Community Ctr
Hussaini, Syed MD
IL Comp Health Insurance Plan
Il Fdn Of Dentistry For Handicap
Jalal Rais Dana
Jennifer Kim
John H. Sengstacke
Johnson, Kim MD
Kagan, Tatyana MD
Khurana, Chandra MD
Kid Care Medical
Kids First Pediatric Partners
Kids Health Partners
Kimball, Valerie MD
Komed Holman Health Center
La Leche League
La Rabida Children's Hospital
Laura Buchanan
Lawndale Christian Health Center
Lawndale Christian Health Center
Lee, John MD
Lincholn park pediatrics
Lincoln Primary Care Physicians
Lincoln Square Medical Center
Lincolnwood Medical Center
Linda Nguuyen
Lurie Children's Hospital of Ch
Lurie Children's Pediatricts
Luries Northbrook Ophthalmology
Luries Uptown Clinic
Lutheran General Children's Hosp
Mark Gerber MD
Mark Hagerty
Martinez, Salud MD
Maulben Patel md
MCWHC
MD at Home
Medical Health Clinic
Mercy Family Health Center
Mercy Hospital
Metropolitan Asian Family Servic
Midwest Express
Midwest Express Clinic
Miles of Smiles, Ltd
Miracle Medical Center
Modi, Rahul MD
Mt. Sinai - Dr. Celio PAC
Mundelein Pediatrics
Near North Health
Nesset Pavilion
New Beginnings Clinic
New Beginnings Prental Program
Nida Blankas-Hernaez, MD
Niles Township Food Pantry
North Shore Associates
North Shore Dental
North Shore Medical Group
North Shore Medical Group
North Shore Pediatric Therapy
North Shore Senior Center
North Shore Skokie
North Suburban Pediatrics
Northbrook OT
NorthShore Adolescent Day School
NorthShore Consultantion/Liaison
Northshore Evanston
NorthShore Northbrook
Northshore Outpatient Clinic
Northshore Pediatrics
NorthShore Pediatrics Skokie
Northshore Skokie
Northshore University Health
NorthShore University Health Sys
Northwestern Medical Group
Northwestern Memorial Hospital
Nutritionist - Betsy Hjelmgren
NW CASA
OakMill Pediatrics
Oakton Health Center
OCampo
Ochs, Todd MD
Orchard Village
Ortega, Fabio MD
Osf Pedatric Bloomington
palatine pediatrics
Patricia Brunner, MD
PCC Community Wellness Center
Pedia Vision
Pediatric Associates Northshore
Pediatric Center Melrose Park
Pediatric Evanston Health Center
Pediatric Medical Services
Pediatric Medical Services
Pediatric Wellness Center
Pediatrician DISABILITY
Pediatrics Association
Pediatrics At The Pavillion
Pediatrics Evanston
Pediatrics Vernon Hills
Peds Rehabilitation Services
Peds Wilmette Plaza Del Lago
PEF Clinic
Peterson Family Health Center
Precious Hearts Pediatrics
Premier Dental Clinic, LLC
Presence Health
Presence Medical Group
Prestige Dental PC
Prime Care Health
Prime Care-West Town
PrimeCare Community Health
Pu Kim MD
puwomg kim DR
Racheal H Hudgins
Rahman-Thomas, Melanie MD
Rainbow Hospice
Rakhee Sheth
Ravenswood Pediatrics
Response Center
Resurrection Health Care
Rhee, Yung MD
RMG Evanston FAM MED
Robinson, Sharon
Rogers Park Family Health Center
Ronald Mcdonald care mobile
Ruiz, JoAnn MD
Rupa Desai, DO
Rush Lifetime Medical Associates
Rush Pediatric Primary Care Cent
Sagan, Andrew MD
Saint Francis Community Health C
Shah, Sudha MD
Shepherd, Kathy MD
Sheridan Medical Center
Sinai Medical Group
Skokie Dental
Skokie Family Center Clinic
Skokie Health Department
Smile IL...the mobile Dentists
St. Anthony's Hospital
St. Francis Hospital
St. Joseph Hospital
St. Mary & Elizabeth Med Ctr
State Of Illinois Family Care
Step By Step Pediatrics
Stroger Hospital Partner
Suburban Pediatrics
Sudhi P. Kurup, MD
Suppl Nutrition Assist. Program
Susan Patel
Swedish Covenant Pediatrics
Swedish Hospital
Swedish Medical Group
Swenson, Kelly MD
Swider, Elizabeth MD
T. Kegan
Tapestry 350 Health - Wilson
Tapestry 360 Health - Devon
Tapestry 360 Health-Lakeview
TCA Health, Inc.
Teens and Tots
Terrizzi, Joseph MD
Thakkar, Ghanshyam S. MD
Total Care Physicians
Touhy Health Center
UIC Children And Adolescent Cent
Universal Smiles
VA Evanston Clinic
Vateva, Ioanna MD
Villiage of Skokie Health Dept.
Vision and Hearing outreach
vista physicians
VNA Health Care
Waukegan Immidiate Care
Wee Speech
West Side Family Center
Winfield Moody Health Center
Wolfe, Robert MD
Yacktman Pediatrics
Zieserl, Edward
Dental Coverage
Children's Health Insurance Program (CHIP)
Combined Medicaid/CHIP
Medicaid
No Insurance
Other
Private Health Insurance
State-Only Funded Insurance
Dentist/Dental Home
1st family dental
1st Family Dental & Midwest Orth
Access Evanston Family Health
advantage dental care
Advocate Medical Group Denistry
Advocate Medical Group Des Plain
Advocate Medical Group Park Ridg
AHS Family Health Center
All Star Dental
Amita Health Medical Group
Anastasia Gianakakos, MD
Anna Bumphrey MD
Anna Kullk-Carlos
Apple Dental Care
Appletree Dental
Asian Human Services
Asian Human Services
Associates for Dental Care
Atrium Health Wake Forest Baptis
Austin Health Center of Cook Cou
Belmont Cragin Health Center
Beyond Smiles
Bright Dental Clark P.C.
Bright Smiles
Brighter Smile Dentistry, P.C.
BrightSmiles Pediatric
Central Dental
Chicago Pediatrics
Chicago Smile Specialists
Children's Dental World
Children's Medicine P.C.
Christian Community Health Cente
colgate
Complete Dental Care
Dental Center (NUHS)
Dental Dreams
Dental Lifeline Network
Dental Matters
Dental Town Lawrence
destiny dental
Diane Henderson
Dillard
Dinkha, Nahrain DDS
DM Family Dentistry
Dr Erika Franco DDS
Dr Reza Ekhtera
Dr. Craig Lehtman
Dr. Frank Karkazis
Dr. Lin
Erie Clinic
Erie Evanston/Skokie Health Cent
Erie Foster Ave Health Center
Erie Humboldt Park Health Center
Erie Telehealth Health Center
Erie West Town Health Center
Euclid Smiles Family Dental
Family Care Glenview Health Cent
family dental
Family Dental of Lincoln
Faubl Family Dentistry
First Family Dental
First Family Dental of Pulaski
Flos Dental
Gentle Family Dental
Hayley Fernandez de Cordova
Heartland Health Center - Devon
Heartland Health Centers - Lake
HEATHER YOON DDS
Illinois Dental
Illinois Dept. of Public Health
Jamie Park Dental
Janet Kuhn & Jeffrey Kramer
Jennifer Kim
Kids First Pediatrics
Lakeshore Dental Inc.
Lakewood Family Dental
lawrence dental group
Library Plaza Dental Center
Lincoln Court Dental
Lurie
Luries Northbrook Ophthalmology
Masonic Dental Clinci
Miles of Smiles, Ltd
Miracle Medical Center
ML Dental clinic
Mobile C.A.R.E. Foundation
Montclare Dental
Mt. Sinai - Dr. Celio PAC
My Smiles Dental Center-FLOS
New Beginnings Clinic
Niles Dental Care
North Broadway Dental
North Shore Dental
North Shore Medical Group
Northshore University Health
NorthShore University Health Sys
Optima Dental Care
Pearl Dental Group
Pearly White Dental Center
Pediatric Dentistry Specialists
preferred dental
Premier Dental Care
Premier Dental Clinic, LLC
Prestige Dental PC
Prime Care-West Town
PrimeCare Community Health
Salih Dental Center
Sinai Medical Group
Skokie Dental
Skokie Dental Clinic
smile
Smile IL...the mobile Dentists
Sonrisa Family Dental
Step By Step Pediatrics
Studio Dental
Sudhi P. Kurup, MD
Swedish Medical Group
Tapestry 350 Health - Wilson
Tapestry 360 Health - Devon
Tapestry 360 Health-Lakeview
TCA Health, Inc.
UIC College of Dentistry
Universal Smiles
Vina Dental
Vinny Sandhu, DDS
VNA Health Care
Does your child have a disability or do you have any concerns about your child's development?
Yes
No
Is there anything else you want to tell us about your child?
Location Preferences
Which program are you applying for? (Required)
Application for children up to age 3
Application for Children 3-5
1st Location Preference
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2nd Location Preference
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- Your Address
- Available Locations
Click a location on the map to see more info
Click here
to find a provider in your area.
Additional Applicant
Do you want to apply now for another child in your family?
Add Another Applicant
Siblings
Are there other children in the family?
Add a Sibling
Thank you for completing your application! We will contact you shortly, by email, with follow up instructions. Please keep an eye out for our message. If you do not receive an email from CNE, please contact us at cne@childcarenetworkofevanston.org.
Required information is missing, see above.