5th Quarter – Application

BEFORE YOU BEGIN — Please review the application first and be sure that you have all of the information you need before filling out the form. You will NOT be able to save your work and return to this form at a later time.

When you have the information you need — fill out the registration form below.

When the registration form is completed and you’re ready — click SUBMIT.
IMPORTANT — Stay on this page until the form is done processing — otherwise, it may not go through. You will receive an email confirming that LUM has received your registration when it is submitted properly. When typing information into this form, please do NOT use only lower case or upper case letter.

  • 5th Quarter – Important Information, click HERE
  • 5th Quarter – main page, click HERE
  • For a PDF version of the 5th Quarter Application & Medication Record Forms, click HERE.

Lafayette Urban Ministry does not and shall not discriminate on the basis of race, color, religion (creed), gender, gender expression, age, national origin (ancestry), disability, marital status, sexual orientation, military status, political association or belief, or union affiliation or activity, in any of its activities or operations.