Child Care Subsidy Application Form
ADVERTISEMENT
1
2
3
4Saskatchewan
Child Care Subsidy Application
Ministry of
Return to: Child Care Subsidy
Social
P.O. Box 2405 Stn. Main
For Office Use:
Services
Regina, SK S4P 4L7
Type of Application
Case Load
Case No.
First Application
Change of Child Care Service
Reapplication
Change of Income
Reporting of Constitutional Status is Voluntary: Status Indian = S Non Status Indian = N Inuit = I Metis = M Non-Native = O
Sex
Birth Date
Social Insurance
Saskatchewan Personal
M-Male
Family Name
Given Name
Number(s)
Year
Month
Day
Health Number
F-Female
Applicant:
|
|
Spouse/Common-Law
|
|
Dependent Children under 18 years-of-age
Please check ( ) if you
are receiving a Child
|
|
Tax Benefit for each
child.
|
|
|
|
Are you receiving
social assistance
|
|
payments from the
Ministry of Social
|
|
Services?
|
|
Yes
No
|
|
Correction area – if the above information or your address has been preprinted incorrectly, please list any changes.
ANSWER ALL OF THE FOLLOWING QUESTIONS:
1.
Please provide the following:
Maiden Name: ____________________________ Alias Name: ___________________________ Other Name: ______________________________
2. Your marital status:
Married
Single
Separated
Divorced
Widowed
3. Are you living common-law?
Yes
No
(You must answer this question if you are not married.)
4. If your marital status has changed since your last application, give date:
|_____|________|______|
Year
Month
Day
5. If you or your spouse/common-law’s income has changed since your last application, please give effective date: |_____|________|______|
Year
Month
Day
6. The Applicant is: 1.
Employed (Complete section A)
The Spouse/Common-law spouse is: 1.
Employed (Complete section A)
2.
Self-employed (Complete section B)
2.
Self-employed (Complete section B)
3.
Seeking employment (Complete section C)
3.
Seeking employment (Complete section C)
4.
Attending an education facility (Complete section D)
4.
Attending an education facility (Complete section D)
5.
Special Need (Complete section K)
5.
Special Need (Complete section K)
7. Are you or your spouse currently a student on a Study Permit issued by Citizenship and Immigration Canada?
Yes
No
8. Are both you and your spouse legally able to work in Canada?
Yes
No
Mailing Address – Please Print
For office use only
Elig. Start:
Term:
|_______|_______|_______|
|_______|_______|_______|
Name
Year
Month
Day
Year
Month
Day
Street or
Reason for Child Care: __________________________________________
Box Number
Case Status: ___________________________ No. of Hol. _____________
City or Town
Letter Type: ___________________________________________________
Postal Code
Assessor’s Signature: ___________________________ Approved: _______
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Education