Application For Child Care Fee Subsidy Page 3
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5F.
Why are you requesting Fee Subsidy? (check all that apply)
Applicant 1
Applicant 2
1. Working:
1. Working:
Full time
Full time
Part time
Part time
Casual
Casual
Self Employed
Self Employed
Place of Employment:____________________
Place of Employment:____________________
Hours Employed per week:________________
Hours Employed per week:________________
2. Student:
2. Student:
Full time
Full time
Part time
Part time
Correspondence
Correspondence
3. Other:
3. Other:
Job Searching
Job Searching
Special Needs (child)
Special Needs (child)
Special Needs (parent)
Special Needs (parent)
Socialization (child)
Socialization (child)
Learning Earning and Parenting (LEAP)
Learning Earning and Parenting (LEAP)
Other: _______________________
Other: _______________________
4. Income:
4. Income:
Ontario Works
Ontario Works
Ontario Disability Support Program
Ontario Disability Support Program
Working
Working
Other: _______________________
Other: _______________________
G. How did you hear about the fee subsidy program?
Child Care Centre
Family and Children’s Services
Ontario Disability Support Program
Ontario Works
Child Care Fee Subsidy Pamphlet
Advertisement: flyer, newspaper
Health Professional
Community info event
Resource Centre/Library
School
Family/Friends
Other: ______________________
H. Are you, your spouse or any of your children involved with any supporting agencies?
Yes
No
If yes, please identify the agency:________________________________________________________
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