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Application

Mom’s House Application

Please PRINT then mail completed application to:
P.O Box 787
415 S. Queen Street
Lancaster, PA 17608-0787

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

Parent Enrollment Application (PDF)