Contact Us

Icon-facebook

Instagram

OUR MODEL
EVENTS
GET INVOLVED
ABOUT
THE DOOR

Apply for Enrollment

Mom’s House offers services to low-income student parents who are dedicated to completing their education.

Please fill out the form below to start your enrollment process.

"*" indicates required fields

Comments

This field is for validation purposes and should be left unchanged.

Name of Enrolling Parent*

First Last

Email Address*

Phone Number*

If we cannot reach you at the phone numbers you've provided, you will be removed from the waiting list.

Alternative Phone Number

Preferred Method of Contact*

Text Message

Phone

You can select multiple options.

Are you currently pregnant?*

Yes

Due Date*

MM slash DD slash YYYY

Date of Enrolling Child's Birth*

MM slash DD slash YYYY

Marital Status*

Married

Separated

Divorced

Single or Dating

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

What school are you attending?*

Projected Graduation Date

MM slash DD slash YYYY

How did you hear about Mom's House?

Family member

Friend

School

Community Agency

Hospital or Clinic

Which school told you about Mom's House?

Which community agency told you about Mom's House?

Which hospital or clinic told you about Mom's House?

Participation Requirements

To be eligible for Mom’s House, students must be enrolled full-time at one of the following local programs:

High school
GED program
College or university
Vo-tech training program
Business school
Nursing school

Additional Requirements

Children must be between the ages of six weeks to five years old
Meet specific income requirements
Maintain passing grades
Volunteer two hours of service at the center (weekly)
Attend at least one hour of parenting education at the center (weekly)
Embrace the Mom’s House mission and philosophy

Subscribe To Our Newsletter

X/Twitter

This field is for validation purposes and should be left unchanged.

Email(Required)

Administrative Offices
722 N. Westwood Ave. | Suite A
Toledo, Ohio 43607

Phone: 419.241.5554
Fax: 419.241.6588

Second Location
2505 Franklin Ave.
Toledo, Ohio 43610

Phone: 419.241.5554
Fax: 419.241.6588

Navigation