Lottery Applications are being accepted for families in Allen, Bartholomew, DeKalb, Delaware, Elkhart, Floyd, Grant, Harrison, Howard, Jackson, Kosciusko, Lake, Madison, Marshall, Monroe, St. Joseph, Tippecanoe, Vanderburgh and Vigo counties. If you are attempting to enter an application for Marion County, please click here

Family Information

 Submit Your Application

*Parent First Name: *Language Spoken in Home:
select
*Parent Last Name: *County of Residence:
select
*Parent Date of Birth:
RadDatePicker
RadDatePicker
Open the calendar popup.
*Are the Parent(s)/Guardian(s) of the child(ren)
applying for service working and/or
attending an education/training program?
**if currently on maternity leave and scheduled
to return to work or school after leave, mark YES.
*How did you hear about
On My Way Pre-K?
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