New Child Care Business Interest Form
Are you interested in starting a new child care business? Complete the form below and we'll get back to you within one business day with information and resources. You will receive an invitation to Learning Community meetings and other information at the email address provided below.
Click here to view this form in Spanish.
First Name
Last Name
Email Address
Area Code & Phone Number
County
Please select...
Adams
Allen
Bartholomew
Benton
Blackford
Boone
Brown
Carroll
Cass
Clark
Clay
Clinton
Crawford
Daviess
Dearborn
Decatur
DeKalb
Delaware
DuBois
Elkhart
Fayette
Floyd
Fountain
Franklin
Fulton
Gibson
Grant
Greene
Hamilton
Hancock
Harrison
Hendricks
Henry
Howard
Huntington
Jackson
Jasper
Jay
Jefferson
Jennings
Johnson
Knox
Kosciusko
LaGrange
Lake
LaPorte
Lawrence
Madison
Marion
Marshall
Martin
Miami
Monroe
Montgomery
Morgan
Newton
Noble
Ohio
Orange
Owen
Parke
Perry
Pike
Porter
Posey
Pulaski
Putnam
Randolph
Ripley
Rush
St. Joseph
Scott
Shelby
Spencer
Starke
Steuben
Sullivan
Switzerland
Tippecanoe
Tipton
Union
Vanderburgh
Vermillion
Vigo
Wabash
Warren
Warrick
Washington
Wayne
Wells
White
Whitley
What type of program would you like to open?
Home
Center
Ministry
Undecided
How many years of experience do you have in early care and education?
Less than 5
Between 5-20
More than 20
When do you expect to open your child care?
As soon as possible
Less than 1 year
Undecided
Have you completed Orientation I?
Yes
No
Unsure
CCR&R Recipient