HMG Apply Now | ELC Nature Coast

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Does the child live in Sumter County? *

Yes

No

Enter the child's zip code

Is the child 8 years or younger? *

Yes

No

Child's First Name

Child's Last Name

Reason for Referral

Relationship to Child

Parent/Guardian First Name:

Parent/Guardian Last Name:

Parent/Guardian Address:

Parent/Guardian Phone Number:

Parent/Guardian Email:

Language Spoken:

Are you a 2-1-1 representative filling out this form on the child's behalf? *

Yes

No

I agree to the Terms and Conditions of the Help Me Grow Program.

View terms of use

Thanks for applying!

Address:

____

Hours:

Monday - Friday

8:00am to 5:00pm

*Lobby closes at 2pm on Fridays

Main Lines:

Citrus County: 352-563-9939

Dixie, Gilchrist, Levy Counties: 352-490-5855

Sumter County: 352-793-5430

____

Fax Line:

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