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Common Forms for Child Care Financial Assistance

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Attendance Forms

Approved Break In Care - January 1, 2022, Open DOCX file, 28.61 KB (English, DOCX 28.61 KB)
Excessive Unexplained Absence Warning Notice -- March 1, 2019, Open DOCX file, 20.74 KB (English, DOCX 20.74 KB)

General Forms

EEC Subsidy File Checklist , Open XLSX file, 41.5 KB (English, XLSX 41.5 KB)
Household Composition Form - September 30, 2021, Open DOCX file, 30.26 KB (English, DOCX 30.26 KB)
Household Income Statement -- March 1, 2019, Open DOCX file, 21.89 KB (English, DOCX 21.89 KB)
Last Day of Employment: Employer Certification -- March 1, 2019, Open DOCX file, 19.1 KB (English, DOCX 19.1 KB)
Last Day of Employment: Parent Certification -- March 1, 2019, Open DOCX file, 21.82 KB (English, DOCX 21.82 KB)
Parent Choice -- March 1, 2019, Open DOCX file, 17.51 KB (English, DOCX 17.51 KB)
Parent Contact Information -- March 1 ,2019, Open DOCX file, 23.46 KB (English, DOCX 23.46 KB)
Parent Enrollment Confirmation Form – June 2020, Open DOCX file, 35.42 KB (English, DOCX 35.42 KB)
Residency Confirmation Form – July 2, 2020, Open DOCX file, 28.99 KB (English, DOCX 28.99 KB)
School Closure Only Form – July 2, 2020, Open DOCX file, 18.54 KB (English, DOCX 18.54 KB)
SMI Calculation Sheet -- March 1, 2019, Open DOCX file, 26.59 KB (English, DOCX 26.59 KB)

Child Care Financial Assistance Agreement

Child Care Financial Assistance Agreement, Open PDF file, 190.18 KB (English, PDF 190.18 KB)

Denial Notice

EEC Notice of Denial August 2023, Open PDF file, 178.67 KB (English, PDF 178.67 KB)

Employment Verification Form

Employment Verification Form - September 30, 2021, Open DOCX file, 59.54 KB (English, DOCX 59.54 KB)

Homeless Forms

Homeless Approval Form -- March 1, 2019, Open DOCX file, 17.44 KB (English, DOCX 17.44 KB)
Homeless Residency Survey -- March 1, 2019, Open DOCX file, 18.36 KB (English, DOCX 18.36 KB)

Parent Transportation Request Form

Parent Transportation Request Form - 2019, Open DOCX file, 21.93 KB (English, DOCX 21.93 KB)

Report of Self Employment Earnings Form

Report of Self Employment Earnings Form -- March 1, 2019, Open DOCX file, 75.38 KB (English, DOCX 75.38 KB)

Request for Review

EEC Request for Review Form August 2023, Open PDF file, 160.74 KB (English, PDF 160.74 KB)

Self Employment Packet Cover Letter

Self Employment Packet Cover Letter - October 13, 2021, Open DOCX file, 27.09 KB (English, DOCX 27.09 KB)

Temporary Change Form

Temporary Change Form – July 2, 2020, Open DOCX file, 21.05 KB (English, DOCX 21.05 KB)

Termination Notice

Termination Notice - September 30, 2021, Open DOCX file, 32.84 KB (English, DOCX 32.84 KB)

Verification of Disability/Special Need of Child

Verification of Disability/Special Need of Child - March 1, 2019, Open DOCX file, 35.44 KB (English, DOCX 35.44 KB)

Verification of Disability/Special Need of Parent

Verification of Disability/Special Need of Parent - 2019, Open DOCX file, 50.02 KB (English, DOCX 50.02 KB)
Variance Request: Special Need of Parent Extension - June 1, 2021, Open DOCX file, 31.56 KB (English, DOCX 31.56 KB)
Initial Special Need of Parent Cover Letter -- May 1, 2021, Open DOCX file, 23.18 KB (English, DOCX 23.18 KB)
Special Need of Parent Renewal Cover Letter -- May 1, 2021, Open DOCX file, 25.79 KB (English, DOCX 25.79 KB)

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