Please fill out online application below OR download pdf form and email it to firstname.lastname@example.org or fax it to 508-929-4040.
Childcare Arrangement Information
Please list all the children for whom you are applying. If your child is not yet born, please include his/her estimated due date and estimated costs. Also, please list all childcare providers and license numbers (or social security numbers), including summer/snow camp arrangements, if any, and the total weekly cost per child. If a child is being cared by multiple providers, please list all providers and the respective total weekly costs.
Thank you for completing Step 1 of the the application process. To complete the Childcare Fund application, please submit the first page of your 2016 1040 Tax Return by email at email@example.com or by fax at 508-929-4040.