Application For Child Care Fee Subsidy Page 2
ADVERTISEMENT
1
2
3
4
5APPLICATION INFORMATION FOR FAMILIES
A. APPLICANT INFORMATION
Surname:
Legal First Name:
Date of Birth (dd/mmm/yyyy):
Address:
City:
Postal Code:
Municipality:
Home Phone:
Work Phone:
Cell:
Marital Status:
Single
Married
Separated
Common Law
Divorced
Email Address:
B.
SPOUSAL INFORMATION
Surname:
Legal First Name:
Date of Birth (dd/mmm/yyyy):
Address:
City:
Postal Code:
Home Phone:
Work Phone:
Cell:
C. Are there any other adults living in the home or using your address?
Name:________________________
Relationship:_______________________
Name:________________________
Relationship:_______________________
D. Canada Revenue Information - please provide the following
Net Income as shown on line 236 of your
Family Net Income as shown on your Canada
OR
Child Tax Benefit Notice for the most recent
Revenue Canada Notice of Assessment
for the most recent taxation year, not your
taxation year.
T1 Summary.
Applicant #1
Year:
Applicant #1
Year:
Line 236 Net Income:
CCTB Net Income:
Applicant #2
Year:
Applicant #2
Year:
Line 236 Net Income:
CCTB Net Income:
E. Fee Subsidy History in Renfrew County
Have you applied for subsidy in the past?
Yes
No
Are your children attending a licensed child care agency or a before and after school program?
Yes
No
If YES, which agency and location? _______________________________________
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal