Parent Enrollment Application

Fill out the form below or print and mail completed application to:

We will call to schedule an interview.

If you have any questions while completing the application—or after you have mailed it back to us—please call and ask for the Program Director or Executive Director. 717.396.9130

Mom’s House is a nonresidential program  and is not a shelter. If you are in need of assistance, please contact one of the following agencies listed below:

  • Water Street Ministries: 717-393-7709
  • Domestic Violence Services of Lancaster County: 717-299-1249
  • YWCA: 717-393-1735
  • TLC (Transitional Living Center): 717-397-0156
  • CHOC (Community Homeless Outreach Center): 717-358-2070
  • Winter Emergency Shelter (December-March): 717-291-5462
  • United Way: 2-1-1

Mail completed application to:

P.O Box 787
415 S. Queen Street
Lancaster, PA 17608-0787