Application for Childcare Assistance

childcareassistformThis benefit is limited to struggling single-parent families who are not receiving federal assistance and have annual incomes $60,000 per year or less. A qualified applicant should not be receiving government assistance TANF (Welfare) or Food Snaps (SNAP).

The child should be living at home in a single-parent family. Other factors affecting the welfare of the child and family may be considered.

The program is currently limited to the Fairfield County, CT area.

We help make childcare affordable.


Application for Childcare Assistance:

Do you need childcare so you can work?

If not, describe reason childcare is needed.
Eligible applicants should not be receiving TANF or SNAP assistance. If you are receiving any of these programs, please check them below. Pell Grants and State Housing Vouchers do not disqualify you from our program.

Employment Information:

(If self-employed, list the name of your company; if recently unemployed... please let us know)
Enter "Current" if already employed.
You may upload a word, pdf, or text file that describes your situation, your childrens needs and why you need child care.
I hereby certify that all the information contained in this application is true and correct. In addition, I have attached a copy of my most recent income tax form. Scholarship requests will not be considered without appropriate documentation. Financial documentation will be used solely to determine eligibility. I also understand that any misrepresentation of the information contained in this document does constitute fraud and will, therefore, deem this application null and void.

Simply sign your name using your mouse below.