Lottery Applications are being accepted for families in Bartholomew, Delaware, Elkhart, Howard, Kosciusko, Madison, Marshall, Monroe, St. Joseph and Tippecanoe counties.

Family Information

 Submit Your Application

*Parent First Name:
*Parent Last Name:
*Parent Date of Birth:
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*Language Spoken in Home:
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*County of Residence:
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*Family Size: Info
*Number of Children
Applying for Pre-K Grant:
*Family's Monthly Earned Income: Info
*Family's Monthly Unearned Income: Info
Foster Care:


* You must include your current mailing address and a phone number and/or email address at which you can be contacted.

Mailing Address


*Address 1:
Address 2:
*City:
*State / Territory: Indiana
*County:
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*Zip Code:

*Phone

NumberTypePrimary
Home Phone
Cell Phone

*Email Address

N/A


Alternate Contact


*Alternate Contact First Name:
*Alternate Contact Last Name:
*Alternate Contact Primary Phone:
*Alternate Contact Secondary Phone:
N/A
*Alternate Contact Email Address:
N/A


* If your child receives a Pre-K Grant we will mail you a notification and call you to set an appointment time with your local Intake Agent to complete
your child's enrollment in an approved Pre-K Program.  If we cannot reach you by mail, phone or email, you will forfeit your grant.

*Children Applying for Pre-K Grant

Info
At least one child is required