Loading..
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form

GETTING STARTED

The information you provide on this application will be used by Beginnings Inc. to determine eligibility for services. Before you start, please have all the information about yourself, your spouse and your children handy.

1. Applicant Information
2. Need For Care (School/Employment)
3. Income Information
4. Child(ren) Information


Income Eligibility Analysis

In order to qualify for child care subsidy programs, your household's gross monthly income must not exceed 70% of the state median income for your household size. Please provide this information below so we can calculate your eligibility.

HOUSEHOLD GROSS MONTHLY INCOME

Your gross monthly income includes any money received from employment, child support, welfare, social security, etc.

NUMBER OF PEOPLE IN HOUSEHOLD

Include yourself, everyone living with you, who is related by blood, marriage or adoption, including your children.

BEGINNINGS ELIGIBILITY LIST AGREEMENT

You must agree to the following terms or we cannot process your application.

Please read and understand the terms below, and check the YES box before proceeding to the next page....

1. I understand that I am placing my name on a list to apply for no or low cost child care services at Beginnings Inc.
2. I understand that receiving services depends on availability of funds.
3. I understand that this is only an application for subsidized child care. This application does not guarantee services
4. I understand that the information that I provide will be verified for accuracy before enrollment into a subsidized child care program.
5. I understand that once I have applied, I can update my application if any of my information changes (such as income, addresses and/or phone numbers, etc.).

Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
APPLICANT INFORMATION (PARENT 1):
CONTACT INFORMATION:
(We REQUIRE at least ONE PHONE NUMBER and ONE EMAIL ADDRESS to process your application. If you do not have one or both of these for whatever reason, please supply the phone number and email of a Relative or Friend that knows how to reach you.)
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
HOME ADDRESS:
(if homeless, then provide your last permanent address)
MAILING ADDRESS:
(leave blank if same as home address)
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
2nd PARENT INFORMATION:
(Required if LIVING IN HOUSEHILD, or has some FINANCIAL RESPONSIBILITY. If not applicable, please proceed to the next page)
2nd PARENT MAILING ADDRESS:
(leave blank if same as home or mailing address of 1st parent)
2nd PARENT CONTACT INFORMATION:
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
Tell us about your need for child care:

Why do you need child care? Check all the boxes below that apply to your situation:

Terms and Definitions:
• Seeking Employment - currently looking for a job
• Medical Incapacitation - verifiable medical conditions that prevents you from caring for your children at least part of the day
• Seeking Permanent Housing - currently homeless
• CPS –Child Protective Services - referral

Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
EMPLOYMENT INFORMATION

Note: If Beginnings calls you for enrollment, you will need to supply documentation of the following:

• Employer Name
• Employer Address
• Work schedule
1st PARENT(Primary Applicant) EMPLOYER INFORMATION:
(If currently unemployed, you may proceed to the next page).
Enter your hourly rate OR gross income (i.e. your monthly salary earned from this employer, including tips and/or commissions BEFORE any taxes or deductions), AND hours worked.
OR
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
2nd PARENT EMPLOYER INFORMATION:
(If currently unemployed, you may proceed to the next page).
Enter your hourly rate OR gross income (i.e. your monthly salary earned from this employer, including tips and/or commissions BEFORE any taxes or deductions), AND hours worked.
OR
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form

INCOME ELIGIBILITY - Tell us about your family's ADDITIONAL income.

Enter income from all sources OTHER THAN WAGES FROM EMPLOYMENT.
Note: All income will be verified prior to enrollment in any child care program. If we call you for enrollment, you will need to supply documentation of the following:

• Wage stubs
• Child support
• Disability
• Public assistance
• Self-employment income
• Social Security
• Spousal Support
• Unemployment
• Worker's Compensation
• Verification of income from any other sources

1st PARENT - ADDITIONAL MONTHLY INCOME:
(i.e. other than wages from employment - fill in all that apply)
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
2nd PARENT - ADDITIONAL MONTHLY INCOME:
(i.e. other than wages from employment - fill in all that apply)
OTHER FAMILY MONTHLY INCOME (fill in all that apply):
Income Adjustments (monthly amount):
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form

CHILD(REN) INFORMATION

Please fill in the fields below for each child in the household under the age of 21.
Note: If Beginnings calls you for enrollment, you will need to supply documentation of the following:

• Immunization records
• Birth certificates
• School or medical records
• County welfare records
• Documentation of child's special needs (IEP or IFSP)
• Contact information for persons authorized to pick up your children
• Court orders regarding custody or child support
• Other reliable documentation indicating your relationship to your children

1st CHILD INFORMATION:
2nd CHILD INFORMATION:
(if there are no more children, please proceed to the next page)
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form
3rd CHILD INFORMATION:
(if there are no more children, please proceed to the next page)
4th CHILD INFORMATION:
(if there are no more children, please proceed to the next page)
Beginnings Child Care Eligibility Form
1 Getting Started
2 1st Parent Info
3 1st Parent Info (cont'd)
4 2nd Parent Info
5 Childcare Reasons
6 1st Parent Employment
7 2nd Parent Employment
8 1st Parent Additional Income
9 2nd Parent Additional Income
10 Children
11 Children (cont'd)
12 Submit Form

Almost Done!

Please remember that this is only an APPLICATION for subsidized child care. YOU ARE NOT APPROVED FOR SERVICES AT THIS TIME. This application does not guarantee services. You are not approved for child care until your application is processed and APPROVED by Beginnings Inc.

After receiving your information we'll check to see if we have everything required for your application. If not, or if we require additional information, we will contact you accordingly.

You can go back to previous pages to verify your information is correct if you wish without losing the data already entered in subsequent pages. When you are ready to submit, just return to this page and hit the submit button... Thank You!