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Forms for Managing Financial Assistance

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Translated Forms

Translated Child Care Financial Assistance Forms 

Attendance Forms

Approved Break In Care - January 1, 2022 (DOCX 28.03 KB)
Excessive Unexplained Absence Warning Notice -- March 1, 2019 (DOCX 20.74 KB)

General Forms

Third Party Verification Form – June 23, 2021 (DOCX 29.76 KB)
EEC Subsidy File Checklist – September 30, 2021 (XLSX 34.14 KB)
Household Composition Form - September 30, 2021 (DOCX 30.26 KB)
Household Income Statement -- March 1, 2019 (DOCX 21.89 KB)
Last Day of Employment: Employer Certification -- March 1, 2019 (DOCX 19.1 KB)
Last Day of Employment: Parent Certification -- March 1, 2019 (DOCX 21.82 KB)
Non-Payment of Parent Fees Warning Notice -- March 1, 2019 (DOCX 20.77 KB)
Parent Choice -- March 1, 2019 (DOCX 17.51 KB)
Parent Contact Information -- March 1 ,2019 (DOCX 23.46 KB)
Parent Enrollment Confirmation Form – June 2020 (DOCX 35.42 KB)
Parent Enrollment Confirmation Form Spanish – June 2020 (DOCX 25.92 KB)
Residency Confirmation Form – July 2, 2020 (DOCX 28.99 KB)
School Closure Only Form – July 2, 2020 (DOCX 18.54 KB)
SMI Calculation Sheet -- March 1, 2019 (DOCX 26.59 KB)

Denial Notice

Denial Notice -- May 1, 2021 (DOCX 25.16 KB)

Employment Verification Form

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

Financial Assistance Agreement

Financial Assistance Agreement – July 2, 2020 (DOCX 25.33 KB)

Homeless Forms

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

Parent Transportation Request Form

Parent Transportation Request Form (DOCX 19.79 KB)

Report of Self Employment Earnings Form

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

Request for Review

Request for Review - September 30, 2021 (DOCX 29.6 KB)

Self Employment Packet Cover Letter

Self Employment Packet Cover Letter - October 13, 2021 (DOCX 26.36 KB)

Temporary Change Form

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

Termination Notice

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

Verification of Disability/Special Need of Child

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

Verification of Disability/Special Need of Parent

Verification of Disability/Special Need of Parent (DOCX 30.1 KB)
Variance Request: Special Need of Parent Extension - June 1, 2021 (DOCX 31.56 KB)
Initial Special Need of Parent Cover Letter -- May 1, 2021 (DOCX 23.18 KB)
Special Need of Parent Renewal Cover Letter -- May 1, 2021 (DOCX 25.79 KB)
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