Snohomish County Child Care Choice Application "*" indicates required fields Head of Household*Please choose a household type.Single MotherSingle FatherTwo parentsGrandparent(s)GuardianOther relativeCaregiver*Enter first and last name of primary caregiver. First Last Second caregiverPlease enter first and last name of secondary caregiver. First Last Primary Caregiver Phone*Primary Caregiver Email* Address* City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Children who need child care- First Name and Age (click on the + sign to add 1 more children)*First NameAge Add RemoveHiddenCountyIslandSan JuanSkagitSnohomishWhatcomHousehold InformationNumber of people in your household including parents/guardians and children below age 18 unless enrolled in high school.*Does your family receive the Working Connections Child Care subsidy?* Yes No I don't know Head of Household Ethnicicy* Hispanic or Latinx Not Hispanic or Latinx Head of Household RaceAmerican Indian/Alaska NativeBlack/African-AmericanAsianWhiteMulti-racialNative Hawaiian/Pacific IslanderOtherUnknownRequest for Emergency AssistanceIs one or both parents/caregivers enrolled in work training or vocational school? Yes No Current situation*Please describe your current work or vocational program. How can child care assistance help you achieve your career goals?Proof of Income DocumentationPlease upload a paystub(s) for the last month for all working parents/caregivers in the household.Max. file size: 25 MB.Child Care InformationIs your child enrolled in a licensed child care program? Yes No What is the name of your child care program?* Please attach a current or projected bill from a licensed child care care or licensed family home.You can attached a scanned pdf or upload a clear picture of the bill with your phone. Accepted file types include doc, docs, pdf, xls, jpeg, and png. Drop files here or Select files Accepted file types: doc, png, jpg, pdf, xls, xlsx, png, docx, Max. file size: 25 MB. Income VerificationYou may qualify for the Child Care Voucher program if you enrolled in an eligible program, OR via your current income.Are you enrolled in one of the following programs?* Children's Health Insurance Program Childcare Subsidies through the Child Care and Development Fund (CCDF) Medicaid Temporary Assistance for Needy Families (TANF) Supplemental Nutrition Assistance Program (SNAP) Free and Reduced-priced lunch (NSLP) and/or school breakfast (SBP) Medicare Part D Low-income subsidies Supplemental Security Income Head Start or Early Head Start Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Section 8 Vouchers Low-income Home Energy Assistance Program (LIHEAP) Pell Grants Early Childhood Education Assistance Program (ECEAP) State Food Assistance Program (FAP) LEP Pathway Refugee Cash Assistance (RCA) PUD Electric and water rate discount None of these programs Monthly Income*Annual IncomeProof of Income*If you are not enrolled in public benefits, please upload proof of income below.Pay StubsEmployer verificationConsent* I agree that information entered above is true
