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Child Care Subsidy Application
Service Member's Name
*
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*
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*
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*
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I am a Single Parent
Spouse's Name
*
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*
Child's Name
*
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Last
Age
*
Age is in:
*
Years
Months
Current Child Care Provider's Name
*
Current Child Care Provider's Location
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
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Iowa
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Northern Mariana Islands
Ohio
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Pennsylvania
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Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Weekly Child Care Cost
*
Acknowledgement of Documentation Requirements
*
The requested documentation listed below is required for your application to proceed. Please note that additional documentation (military ID and a completed W9 for your current child care provider) will also be required if your application is conditionally approved. These items will need to be delivered in person to protect personal identity information. Delivery of these documents is a condition of final approval.
I understand
Upload Supporting Documents
*
Please attach the following four (4) documents: Spouse employment verification letter, Proof of MCCS Childcare Waitlist, Proof of Fisher Children's Center Waitlist, Proof of childcare enrollment that shows weekly rate
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Max. file size: 10 MB.
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