HELP New Mexico, Inc. Child Application
This application is used to determine eligibility for all HELPNM Office of Learning & Academic Opportunity. Please answer all the questions on the form, sign application and return for a certification interview. If you need assistance with this application, please contact center staff. Thank You.

Section 1: Parent/Legal Guardian (Primary Caregiver)

Gender
Home Address
Home Address
City
State/Province
Zip/Postal
Mailing Address if different from Home Address
Mailing Address if different from Home Address
City
State/Province
Zip/Postal
Family Type (check one)

Section 2: Child(ren) Applying for Child Development Services

Complete the following for each child applying for Child Development Services:

Gender

Section 3: All Other Household Members

Complete the following information for all other people who live with you that are supported by your income and related
to you by blood, marriage, or adoption.
(Do not list the children already listed above.)

Gender
Please upload applicable documents here (immunizations, etc.)
Maximum upload size: 516MB
I understand that the information provided is correct to the best of my knowledge and this information will be kept in strict confidence. All information provided is used to determine eligibility and priority selection.

FOR OFFICE USE ONLY

Time Application Received
: