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Name, Date of Birth, School or Childcare, and which days each child is enrolled:
• 2018 Federal Income Tax Return (complete and signed)
• 2018 W-2’s from all employers
• CURRENT PAY STUB from all employers
• IF SELF EMPLOYED – current (YTD) Profit/Loss Statement and complete set of business taxes
• Child’s proof of legal presence (United States birth certificate or United States passport)
• Client responsibility agreement – signed & dated
• Employment verification – filled out by employer- one is required for each job held
Assets and Liabilities – filled out and signed and dated
• Child Support Affidavit – if applicable
**Completion of this application does NOT guarantee that you will receive financial aid**
Please list the name, address, dates of employment and your gross monthly income from this employer:
Please list any other sources of income for anyone in the household; include child support, alimony, social security, dividends, or other.
In providing the above information, applicant(s) declares the same to be voluntarily furnished. Applicant(s) hereby grants the Kids First Board the right to request verification thereof through persons and/or entities disclosed and/or hereinafter disclosed. Applicant(s) declares the above information is true and accurate. Applicant(s) declares that the information on this application is understood by the applicant(s).
I authorize Kids First, licensed childcare programs, Human Services (CCCAP) and other necessary agencies to release pertinent information in order to better coordinate services for my child (children).
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
This field is not part of the form submission.
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