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The Official Website of the Executive Office of Education (EDU)
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  3. Early Education & Care
  4. Provider and Program Administration
  5. Forms for Program Administration
  6. Early Education and Care Program Forms
  7. Forms for Family Child Care Programs
  8. Family Child Care Assistant Application Forms

Family Child Care Assistant Application Forms (new or renewal)

  • FCC Assistant Application and Checklist links to PDF file

    This licensing application is for all individuals interested in applying to become a regular or certified assistant in a family child care home. This form is for new and renewal applicants. DOC
  • Assistant Application Checklist (Khmer) pdf format of 			Assistant Application Checklist (Khmer)

    This checklist must be submitted to EEC with new and renewal Family Child Care Assistant applications.
  • Lista de verificación ayudante de Aplicación pdf format of 			Lista de verificación ayudante de...

    Complete this form to provide information about any assistants you may have on staff.
  • Lista de conferência assistente de Aplicação pdf format of 			Lista de conferência assistente de...

    This checklist must be submitted to EEC with new and renewal Family Child Care Assistant applications.
  • Background Check Form (Khmer) pdf format of 			Background Check Form (Khmer)

    This form is part of the application process for providers/assistants who wish to provide child care or to act as an assistant in a Family Child Care program. In addition, each household member age 15 and over and each individual age 15 and older regularly on the premises of a family child care applicant's or provider's home must complete this form.
  • Forma de Cheque de Registro de fondo pdf format of 			Forma de Cheque de Registro de fondo

    This form is part of the application process for providers/assistants who wish to provide child care or to act as an assistant in a Family Child Care program. In addition, each household member age 15 and over and each individual age individual age 15 and older regularly on the premises of a family child care applicant's or provider's home must complete this form.
  • Forma de Cheque de Registro de fundo pdf format of 			Forma de Cheque de Registro de fundo

    This form is part of the application process for providers/assistants who wish to provide child care or to act as an assistant in a Family Child Care program. In addition, each household member age 15 and over and each individual age 15 and older regularly on the premises of a family child care applicant's or provider's home must complete this form.
  • Family Child Care Medical Form links to PDF file

    This form is completed by the child care provider's physician or health care professional. DOC
  • Payment Instruction Sheet for Certified Assistants pdf format of 			Payment Instruction Sheet for Certified Assistants

    Detailed instructions on how to submit your application payment for certified assistants.
  • Payment Instruction Sheet for Certified Assistants (Khmer) pdf format of 			Payment Instruction Sheet for Certified Assistants

    Detailed instructions on how to submit your application payment for certified assistants.
  • A Folha de Instrução de pagamento para um Assistente Certificado pdf format of 			Certified Assistant Applic. Payment Instructions

    Detailed instructions on how to submit your application payment for certified assistants.
  • Fee Schedule pdf format of 			Fee Schedule

    This schedule identifies licensing application fees for all childcare programs.
  • Fee Schedule for Family Child Care (Khmer) pdf format of 			Fee Schedule for Family Child Care (Khmer)

    A listing of the different types of fees assessed based on the services your child care facility provides.
  • Tabla de tarifas para solicitudes pdf format of 			Tabla de tarifas para solicitudes

    A listing of the different types of fees assessed based on the services your child care facility provides.
  • Plano de taxas para pedidos pdf format of 			Plano de taxas para pedidos

    A listing of the different types of fees assessed based on the services your child care facility provides.
  • Authorization to Release Information (from Previous Employer) pdf format of 			Authorization to Release Information (from...

    Filling out this form gives the Department of Early Education and Care (EEC) the authorization to obtain any and all information about your employment history.
  • Family Child Care Assistants - A Guide for Educators links to PDF file

    This guide for Family Child Care providers provides information, directions and licensing requirements when using regular or certified assistants in your home. DOC

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