Affordable Childcare Subsidy Application
Applicant Information
Parent/Guardian Full Name
Date of Birth
Address
Phone Number
Email
Child Information
Child's Full Name
Date of Birth
Relationship
Household Information
Number of People in Household
Number of Children (under 18)
Annual Household Income
Employment / Education
Parent/Guardian Employment Status
Employed
Self-Employed
Student
Unemployed
Other
Employer/School Name
Childcare Details
Childcare Provider Name
Type of Care
Childcare Center
Home-Based
Other
Start Date
Hours per Week
Declaration
I declare the information provided is accurate.