615 North 22nd Street, Lafayette, IN  47904

Phone 447-2204

Application Forms

There are two forms that must be printed and filled out.  You can access them at the following links and then print them on your printer.

Form:    GETTING TO KNOW YOU

• Download PDF file "Getting to Know You"

Form:   State Form 45877  Health Care Program

• Download PDF file 45877

Form:    Registration Form

• Download PDF file "Grace Readiness Registration"

Note:  You must have Adobe Reader installed to download and print these files.  If you need the reader, click the following link to download it:

  "Get Adobe Reader"