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Approved Break In Care - January 1, 2022
(English, DOCX 28.03 KB)
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- This page, Common Forms for Child Care Financial Assistance, is offered by
- Department of Early Education and Care
Common Forms for Child Care Financial Assistance
Table of Contents
Attendance Forms
General Forms
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EEC Subsidy File Checklist – September 30, 2021
(English, XLSX 34.14 KB)
Open DOCX file, 30.26 KB,
Household Composition Form - September 30, 2021
(English, DOCX 30.26 KB)
Open DOCX file, 21.89 KB,
Household Income Statement -- March 1, 2019
(English, DOCX 21.89 KB)
Open DOCX file, 19.1 KB,
Last Day of Employment: Employer Certification -- March 1, 2019
(English, DOCX 19.1 KB)
Open DOCX file, 21.82 KB,
Last Day of Employment: Parent Certification -- March 1, 2019
(English, DOCX 21.82 KB)
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Parent Choice -- March 1, 2019
(English, DOCX 17.51 KB)
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Parent Contact Information -- March 1 ,2019
(English, DOCX 23.46 KB)
Open DOCX file, 35.42 KB,
Parent Enrollment Confirmation Form – June 2020
(English, DOCX 35.42 KB)
Open DOCX file, 28.99 KB,
Residency Confirmation Form – July 2, 2020
(English, DOCX 28.99 KB)
Open DOCX file, 18.54 KB,
School Closure Only Form – July 2, 2020
(English, DOCX 18.54 KB)
Denial Notice
Open PDF file, 178.67 KB,
EEC Notice of Denial August 2023
(English, PDF 178.67 KB)
Employment Verification Form
Financial Assistance Agreement
Homeless Forms
Open DOCX file, 17.44 KB,
Homeless Approval Form -- March 1, 2019
(English, DOCX 17.44 KB)
Parent Transportation Request Form
Report of Self Employment Earnings Form
Open DOCX file, 75.38 KB,
Report of Self Employment Earnings Form -- March 1, 2019
(English, DOCX 75.38 KB)
Request for Review
Open PDF file, 160.74 KB,
EEC Request for Review Form August 2023
(English, PDF 160.74 KB)
Self Employment Packet Cover Letter
Open DOCX file, 26.36 KB,
Self Employment Packet Cover Letter - October 13, 2021
(English, DOCX 26.36 KB)
Temporary Change Form
Termination Notice
Verification of Disability/Special Need of Child
Verification of Disability/Special Need of Parent
Open DOCX file, 30.1 KB,
Verification of Disability/Special Need of Parent - 2019
(English, DOCX 30.1 KB)
Open DOCX file, 31.56 KB,
Variance Request: Special Need of Parent Extension - June 1, 2021
(English, DOCX 31.56 KB)
Open DOCX file, 23.18 KB,
Initial Special Need of Parent Cover Letter -- May 1, 2021
(English, DOCX 23.18 KB)
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