This is a pre-application and does not mean that you will be enrolled in a program. After receiving the pre-app, ICHS will be in contact with you to explain the procedure for a full application. If you have any questions regarding the program, please contact Cheryl by calling 515-245-7800 or click here to email her.

Required fields are marked (*)

* Select Program of Interest:

* Name:

* Address:

* City:

State:

* Zip Code:

* Phone/Message#:

School Attending:

Current Grade:

* Birth Date:

Did you receive free school lunch

Number of persons in your family

Gross Family Income (last 6 months)

Check all benefits your family receives or what qualification will make you eligible for the program.