IMPORTANT! READ THIS FIRST!!
An application packet is included for you to complete. Please read all instructions carefully before you begin.
All application materials must be completed in full and returned to our office before your eligibility can be
determined. Applications that are not complete may delay your eligibility determination.
Please include the following:
Signed and dated application.
Copy of social security cards for all family members.
Birth certificates for all family members to verify family composition.
Written approval by Bucks County Children and Youth agency that the foster child may
receive subsidized child care, along with the stipend amount if received. (If applicable)
Proof of Income:
Employment form filled out by EMPLOYER (all applicants)
Tips (if applicable)
Last year’s Schedule C tax form if self-employed.
Training Allowances (if applicable)
Income from Rent/Room/Board (if applicable)
Four (4) consecutive weeks of most recent pay stubs that AVERAGE TWENTY (20) HOURS
PER WEEK OR MORE:
If paid bi-weekly or twice a month, TWO pay stubs
If paid weekly, FOUR pay stubs.
Proof of Unearned Income:
Child Support, SSI, Disability Benefits, etc.
Temporary or permanent disability forms filled out by treating physician (if applicable)
Proof of medical costs, which consistently exceed 10% of gross monthly income incurred
within the last six months (if applicable)
Consent for the Release of Information signed and dated by parent/guardian.
Education Verification (if applicable)
Residence Address Verification.
Parent Schedule Review form.
IF YOU ARE NOT MEETING THE TWENTY (20) HOUR PER WEEK WORK REQUIREMENT, YOU WILL
IMMEDIATELY BE DETERMINED INELIGIBLE. If you are unable to submit any of the above items, we may be
able to accept an alternate form of verification. To learn more about submitting another form of verification
or if you have questions about any of these items listed above, please call us at 1-800-371-2109 and we will
be glad to assist you. Thank You.
APPLE CHILD CARE SERVICES, INC
CCIS of Bucks County/ Apple Child Care, 70 W. Oakland Ave., Suite 210 Doylestown, PA 18901
1-800-371-2109 or (215) 348-1283 FAX: 215-348-9397
Visit us at