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Application for Child Care Services


  1. 1. Applicant Information
  2. 2. Employment / Training / Education
  3. 3. Other Household Income
  4. 4. Other Household Members
  5. 5. Terms & Conditions
  • Applicant Information

    1. To apply for Child Care Services, please complete and submit the form below.
    2. How did you hear about us?*
    3. Information is Voluntary
    4. Hispanic*
    5. Gender*
    6. Is your Physical Address different from your Mailing Address?*
    7. Other Methods of Contact*
    8. Marital Status*
    9. Do you have over $1,000,000 in assets?*
    10. Is there a 2nd parent in the household?*
    11. Information is Voluntary
    12. Hispanic*
    13. Check all that apply to determine if you may qualify as a priority group (verification may be required)
    14. Spouse of Veteran Defined
      You are a Spouse of a veteran if any of the following are true: Spouse died of a service-connected disability; Spouse is considered MIA / captured / forcibly detained; Spouse has a total disability resulting from service-connected disability as determined by the VA; Spouse died while a disability was in existence; Spouse died while serving on active duty
    15. Receiving Eligibility-Based Workforce Services Defined
      You are receiving eligibility-based services if any of the following are true: You submitted an application and/or provided personal information in order to qualify for workforce services you are now receiving; You are receiving support services such as transportation-related assistance in the form of bus passes or money on a reloadable debit card; You are in training for which Workforce Solutions is paying all or part of the costs; You are in a work placement / internship position that was arranged by Workforce Solutions with the employer, and Workforce Solutions is funding all or part of your wages; You are looking for a job or doing some other activity in which you meet with a Workforce Solutions staff person on a regular basis (such as weekly or monthly appointments)