Parent Enrollment Application

Apply Online below or print and mail completed application

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

Mail completed application to:

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

Apply Online


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

*It is the policy of Mom’s House not to discriminate on the basis of race, color, national or ethnic origin, political or religious opinion or affiliation, age, sex, or handicapping condition in the recruitment or admissions of clients, and in the hiring of staff.

**This information is needed for an annual report with the Commonwealth of PA to conform with anti-discrimination laws. You are not required to fill this out.

*La póliza de la casa de mamá no es discriminar por motivos de raza, color, origen nacional o étnico, opinión o afiliación política o religiosa, edad, sexo o condición de minusvalía en la contratación o admisión de clientes, y en la contratación de personal.

**La siguiente información es necesaria para un informe anual con la Mancomunidad de Pensilvania para cumplir con las leyes antidiscriminatorias. No es necesario que completes esto.