Before filling out our Preliminary Application for Services please make sure you met the following requirements:

  • You must be a single mother (no other adult in the home)

  • You may have up to three children under the age of 13 at home

  • Your annual income must be less then 2x the poverty level based on the number of persons in your home. We follow the 2019 Federal Register Guidelines. For example your annual income must be under:

    • Mother + 3 Children = $51,500 ($25,750 x 2)

    • Mother + 2 Children = $42,660 ($21,330 x 2)

    • Mother + 1 Child = $33,820 ($16,910 x 2)

  • You are employed, going to school, or attending a training during hours of approximately 3:00pm to 7:00am the following day on Monday-Friday and 24 hour services on Saturdays & Sundays.

We will responded to you within 10 days of receipt of your application. If you have questions or concerns please contact April Matt at or 267-382-9607.

Name *
Address *
Phone *
Please list all children that live in your home.
Please separate each child by a comma.
Please choose the option closest to your monthly income.
Please choose the option closest to your other monthly income.
Employer/School's Address *
Employer/School's Address
Employer/School's Phone *
Employer/School's Phone
This will help determine the hours you will need childcare.
By signing this you agree to a home visit prior to final acceptance into the ATW program.