Fillable Child Care Request Form printable pdf download

Child Care Request Form

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CHILD CARE REQUEST FORM

Date Form is being completed______________

Name:_______________________________________________________

Student ID or SSN#:____________________________________________

Phone Number:________________________________________________

Student e-mail address:__________________________________________

How many children are needing childcare assistance:______________________

Number of children that are attending public school and need before/after school

care and teacher workday care:_________________________

Number of children needing childcare and are not attending public

school:___________________________________

For which semester are you requesting assistance with

childcare?______________

Have you completed the Free Application for Federal Student Aid(FAFSA):

Yes____No____

Will you receive DSS assistance?

Yes______No______

This form must be submitted to Myra Sanders, Special Populations Coordinator to

be considered for Childcare Assistance. You may submit the form by e-mail at

msanders@cccti.edu

or to either one of the Financial Aid Offices on the Watauga

or Hudson Campus.

Child Care Request Form

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