Additional information may be needed to complete your application to the Child Care Financial Assistance (subsidy) program.

Financial Assistance Program Application
Form to apply for the program, once completed please send to your local Community Child Care Support Agency. You may also pick up a printed form at a local Community Child Care Support Agency.

Supplemental forms for the program application:

• Verification  of Employment - if you work include either two consecutive paystubs or this form with your application.
• Self-employment business plan - if you or your partner own your own business include either your last year's taxes, or this form.
• School/Training plan - if you or your partner need child care so that you can attend school or a training program use this form.
• Special health need (adult) - if you or your partner are unable to care for your children due to a medical condition use this form.
• Special health need (child) - if your child has a special need and child care is part of their individualized education plan use this form.
• Looking for employment - if you or your partner need child care while you are looking for a job use this form.

Consent to Exchange Information Form
Use this form to give permission for the eligibility specialist to get other information from other agencies and people.

School Age Summer Schedule Form
When your school age child's schedule changes in the summer, use this form to notify the eligibility specialist of the changes.

Additional Information:

• Financial Assistance Program Income Fee Scale
• Financial Assistance Program Child Care Rates
• Financial Assistance Program Legally Exempt Child Care (LECC) Providers Rate