YWCA Cares Program Application

YWCA knows many families are experiencing additional stress and frustration during COVID-19. The YWCA Cares program aims to provide respite care to families in need for a variety of reasons. This application will help determine if your family qualifies for this program.

Name*
First Last
Phone*
Email
Are you any of the following? (Check all that apply)
- A veteran currently living in Texas
- Pharmacy or healthcare worker
- Local or state government worker
- Restaurant or food delivery worker
- First responder
- Gas station employee
- Childcare/home health provider, or other caregiver
- Mail/delivery worker
- Military Personnel
How many children between the ages of 0-12 currently live with you?*
The YWCA Cares program seeks to provide respite to parents during COVID-19. Please provide an overview of why you are requesting to participate in this program.*