Family Application

Apply for daycare assistance

Fill out the form below to apply. We'll review your application and get back to you as quickly as possible. All information is kept confidential.

Parent/Guardian Information
The applying parent or legal guardian of the child.
Optional, but helps us reach you faster.
Child Information
Information about the child who needs daycare.
Optional but helps us verify eligibility.
Incarcerated Father's Information
We use this to verify eligibility. All data is kept strictly confidential.
Found on the Bureau of Prisons website or sentencing paperwork.
Daycare Preference
Let us know where you'd like your child to attend, or if you need help finding a center.
Your information is confidential and will only be used to process your application for daycare assistance. We do not share your data with law enforcement or any third parties.
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Application Received

Thank you for applying. We'll review your application and reach out within 3-5 business days. Keep an eye on your email.

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