We are excited about the opportunity to serve you and your child(ren). Please continue by completing an ONLINE Application. Our goal is to have parents complete the online application process and then we will call you for an appointment to sign all forms.
If you are not able to complete an online application, we will have enrollment events scheduled soon. Please note, we request that children do not come with you to complete forms. Public restrooms will not be available. We will respect the social distancing order of the Governor, masks will be required, and temperatures will be taken prior to entry of the building.
By completing an application, it will not guarantee you are enrolled as we will enroll children based on age and income, and not by the first-come-first-served basis.
We look forward to meeting you in person in the near future.
How to Apply
Apply online, at an enrollment event, or call our office at (574) 393-5864 to schedule an appointment.
before continuing to step 1, please read the Step by Step Instructions Located in the link below.
Step 1: Apply Now
Step 2: Click the link below to Open additional Documents and then download.
After you have completed the additional documents, please save the PDF to your desktop, then attach the PDF and email to [email protected]
If possible, snap a picture or scan the required documents listed below and email them to [email protected] or bring them to your face-to-face appointment.
When applying online, if possible, snap a picture or scan the required documents and email them to [email protected] or bring them to your face-to-face appointment.
When applying at an Open Enrollment event or at our office, bring the required documents/information with you.
- Birth Certificate – a copy is required.
- Immunization Record – (if child has not been immunized, please see the doctor first).
- Income records from most recent full tax year (preferred: tax return, or W2, public assistance, etc.)
- Medicaid or Hoosier Health Wise card for child.
- Child Support (current 12 months printout).
- Private Insurance card if child is covered under a family plan.
- Name, address, and phone numbers of Childs medical and dental doctors.
- 3 Emergency Contacts: names, valid & working phone numbers and addresses.