HELP for Childcare: Pre-Application

  • HELP for Childcare: Pre-Application

  •  

    We are at currently at capacity and unable to assist new keiki.

    WHAT DOES THIS MEAN?

    We have reached our capacity for this year. We will keep your 'ohana on a waitlist once you submit this pre-application and contact you in order once we are open to enrolling new keiki again.

    Please check back here on August 1, 2026 to see if we have space available at that time. 

    Please feel free to contact us at helpapp@koka.org if you have any questions. Mahalo nui for your understanding!

  • Child #1

  •  - -

  • Families with Special Needs include:

    • child with medically-documented special needs
    • children in long-term foster care who are U.S. citizens or legal permanent residents
    • children in care of adults in protective services
    • transitioning from homelessness
    • children of incarcerated parents
    • child of minor teenaged birth parents
    • child affected by natural disaster or loss of home in Hawaii
  • Do any of the situations listed above apply to Child #1?*
  • Does Child #1 possess Native Hawaiian, American Indian, or Alaska Native ancestry?*

  • Child #2

  •  - -

  • Families with Special Needs include:

    • child with medically-documented special needs
    • children in long-term foster care who are U.S. citizens or legal permanent residents
    • children in care of adults in protective services
    • transitioning from homelessness
    • children of incarcerated parents
    • child of minor teenaged birth parents
    • child affected by natural disaster or loss of home in Hawaii
  • Do any of the situations listed above apply to Child #2?
  • Does Child #2 possess Native Hawaiian, American Indian, or Alaska Native ancestry?

  • Child #3

  •  - -

  • Families with Special Needs include:

    • child with medically-documented special needs
    • children in long-term foster care who are U.S. citizens or legal permanent residents
    • children in care of adults in protective services
    • transitioning from homelessness
    • children of incarcerated parents
    • child of minor teenaged birth parents
    • child affected by natural disaster or loss of home in Hawaii
  • Do any of the situations listed above apply to Child #3?
  • Does Child #3 possess Native Hawaiian, American Indian, or Alaska Native ancestry?

  • Applicant (& Co-Applicant) Activity Status

    Employment, Schooling, or Job Training
  • Applicant Activity Status:*
  • Co-Applicant Activity Status:
  • Are your total family assets less than $1 million?*
  • Format: (000) 000-0000.
  • Is your Home Address the same as your Mailing Address?*
  • How did you hear about our program?
  • Should be Empty: