Lottery Applications are being accepted for families in Allen, Jackson, Lake, Marion, and Vanderburgh counties. If you are attempting to enter an application for Marion County, please click here

Family Information

 Submit Your Application

*Parent First Name:
*Parent Last Name:
*Parent Date of Birth:
RadDatePicker
RadDatePicker
Open the calendar popup.
*Language Spoken in Home:
select
*County of Residence:
select
*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:
select
*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