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4-C: Community Coordinated Child Care

Forms

CHILD CARE ASSISTANCE PROGRAM FORMS

Child Care Application: The application is used when initially applying for child care or when a previous child care case is no longer active. The application can be completed online or printed off.

Wage Verification Form: This form is used to verify income for families paid in cash or have just begun a new job and are waiting for two consecutive check stubs.

Evaluation Form: Your input on our services is very important to us. Please take a moment to complete the evaluation and send it to us with your form(s).

Español

Child Care Application-Spanish: La alicación se utiliza cuando alguien inicialmente aplica para cuidado de niños o cuando un caso de cuidado de niños anterior ya no está activa. La solicitud puede ser completada en el internet o imprimirse.

Formulario De Verificación De Salario: Este formulario se utiliza para verificar los ingresos de las familias que les pagan en efectivo o acaban de comenzar un nuevo trabajo y están a la espera de dos talones de cheques consecutivos.

Formulario De Evaluación: Su opinión sobre nuestros servicios es muy importante para nosotros. Por favor tome un momento para completar la evaluación y enviarlo a nosotros con su forma.

FOOD PROGRAM FORMS

Enroll in the Food Program

Provider Direct Deposit

Physician Statement for Food Substitution

Parent Request for Non-Dairy Milk Substitute

Providers Applying for Tier 1 by Income

Parent/Guardian Application

TRAINING PROGRAM FORMS

CPR/First Aid Funds for CCAP Providers Only

Reimbursement application and guidelines for individuals – This is for providers who have registered for a training as an individual

Reimbursement application for centers who have taken the training as a group – This is for center programs who arrange an instructor to provide a group training

Quality Improvement Cohort Forms (FY19)

Cohort Timeline

CQIP Planning Worksheet–Hand Complete

CQIP Planning Worksheet–Computer Complete

Cohort ERS Scale Assessment Form–Hand Complete

Cohort ERS Scale Assessment Form–Computer Complete

CQIP Summary–Hand Complete

CQIP Summary–Computer Complete

Cohort Budget–Computer Complete

Budget Compilation–Computer Complete

QIF Cohort Paperwork Checklist

Receipt Reconciliation Report