offered by
Department of Early Education and Care

Forms for Managing Financial Assistance

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Table of Contents

General Forms

Approved Break In Care -- October 1, 2018 (DOCX 17.68 KB)
Attendance Notification Agreement -- October 1, 2018 (DOCX 371.06 KB)
EEC Subsidy File Checklist -- October 1, 2018 (PDF 266.06 KB)
Household Composition -- October 1, 2018 (DOCX 18.57 KB)
Household Income Statement -- October 1, 2018 (DOCX 19.52 KB)
Information Sheet for Families -- October 1, 2018 (updated 10.25.18) (DOCX 24.01 KB)
Last Day of Employment -- October 1, 2018 (DOCX 18.88 KB)
Parent Choice -- October 1, 2018 (DOCX 18.26 KB)
Parent Contact Information -- October 1, 2018 (DOCX 22.95 KB)
SMI Calculation Sheet -- October 1, 2018 (DOCX 26.86 KB)
Variance Request: Special Need of Parent Extension -- October 1, 2018 (DOCX 22.27 KB)

Children with Disabilities/Special Needs Flexible Funding

Children with Disabilities/Special Needs Flexible Funding Application Request (DOC 56.5 KB)
Disabilities/Special Needs Flexible Funding Budget Request (DOC 55 KB)
Disabilities/Special Needs Flexible Funding Checklist (PDF 124.13 KB)
Guidance for Reviewing Requests for Accommodation and Special Needs Flexible Funding Requests for Children with Disabilities (PDF 388.31 KB)

Denial Notice

Denial Notice -- October 1, 2018 (DOCX 20.81 KB)

Employment Verification Form

Employment Verification Form -- October 1, 2018 (updated 10.25.18) (DOCX 51.29 KB)

Financial Assistance Agreement

Financial Assistance Agreement -- October 1, 2018 (updated 10.25.18) (DOCX 23.3 KB)

Parent Transportation Request Form

Parent Transportation Request Form -- October 1, 2018 (DOCX 19.78 KB)

Report of Self Employment Earnings Form

Report of Self-Employment Earnings Form -- October 1, 2018 (updated 10.25.18) (DOCX 72.99 KB)

Request for Review

Request for Review -- October 1, 2018 (DOCX 18.11 KB)

Self Employment Packet Cover Letter

Self Employment Packet Cover Letter -- October 1, 2018 (DOCX 18.32 KB)

Temporary Change Form

Temporary Change Form (DOCX 20.92 KB)

Termination Notice

Termination Notice -- October 1, 2018 (DOCX 21.14 KB)

Verification of Disability/Special Need for Child

Verification of Disability/Special Need for Child -- October 1, 2018 (DOCX 32.54 KB)

Verification of Disability/Special Need of Parent

Verification of Disability/Special Need of Parent -- October 1, 2018 (DOCX 30.55 KB)
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