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Child Care Pre-Application



Family Benefits

Other Household Members

Applicant Status

Spouse Status

This section is required in order to determine if you meet the income eligibility. Proof of income will be required when funds become available and you are contacted for intake.

Please include all household (gross) income from wages earned by all household members, child support, parental contribution, Social Security Benefits, TANF, Unemployment Insurance, Workman's Comp, and any other income received in the household.

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