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Child Care Aware NW Washington

Child Care Aware NW Washington

Advancing early learning opportunities in child care settings

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  • Home
  • About Us
    • Commitment to Racial Equity
    • What We Do
    • Staff
    • Contact Information
    • Publications
    • Advocacy
  • For Families
    • Finding a Child Care Program
    • Paying for Child Care
    • Play and Learn Groups
    • Early Achievers for Families
  • Providers
    • Starting a Child Care Business
    • Early Achievers QRS for Providers
    • STARS Training
    • In-Service Stars Training
    • Infant Toddler Coaching & Consultations
    • Electronic Attendance System
    • Provider Update Form
    • Post a Job
  • C-RECC
Family Size and Income Guidelines 60% Area Median Income
Income 2 3 4 5 6 7
Monthly $4,629.17 $5,208.33 $5,788.33 $6,245.3 $6,712.50 $7,175.00
Annual  $62,160 $69,900 $77,640 $83,880 $90,120 $96,300

 

Snohomish County Child Care Choice Intake Form

"*" indicates required fields

Household Information

Optional
Parent/Caregiver
Enter first and last name of primary caregiver.
Needed for database entry
MM slash DD slash YYYY
Optional
Second parent/caregiver if applicable
First and last name of secondary caregiver.
Needed for database entry
MM slash DD slash YYYY
Address
Interpretation/Translation Needs
Children
Name
Birthdate - format mm/dd/yyyy
 
Please choose a head of household type from the dropdown list.
Head of Household Ethnicicy
Does family receive the Working Connections Child Care subsidy?

Request for Financial Assistance

Is one or both parents/caregivers employed?
Hidden
Employer 1 Address
Hidden
Employer 2 Address
Hidden
Hidden
Is one or both parents/caregivers unemployed and looking for work?
Is one or both parents/caregivers unemployed and enrolled in work training or vocational school?
Enter the program name, affiliated school or entity, and location. (e.g. Home Care Health Training, Catholic Community Services, Edmonds, WA)
Enter estimated training end date.
MM slash DD slash YYYY

Referral Information

Name of community partner referring client
Referral Contact
Hidden
Hidden

Child Care Information

Please describe current work or vocational program. How can child care assistance help client achieve employment or career goals?
Is child(ren) enrolled in a licensed child care program?
Child Care Provider Contact Name
Child Care Program Address
W9 on file?
Is this program new to Opportunity Council vouchers? If yes, be sure to send new vendor information.
Target Child Care Coverage Start Date
Target Child Care Coverage End Date
Enter monthly rates for childcare. If the provider charged weekly rates, multiply weekly rate by 4.3 for estimated monthly.
Enter estimated total for other fees, e.g. activity fees, field trips, etc.
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
Accepted file types: doc, png, jpg, pdf, xls, xlsx, png, docx, Max. file size: 25 MB.

    Income Verification

    Families may qualify for the Child Care Voucher program if enrolled in an eligible program or via current income if household earns up to 60% of the area median income.
    Is the family enrolled in one of the following programs?
    Please upload an enrollment letter or other documentation to show enrollment in a public benefits program. If not enrolled in a public benefit program, paystubs for the last 30 days are okay as long as the pics are clear and not too fuzzy.
    Max. file size: 25 MB.

    Approval Notes

    Describe logic used to determine total months of approval and approval amounts. More information is better than too little.
    Enter the total number of months for initial approval. Can be extended if needed with approval .
    Auto-calculates the maximum amount for initial approval. Multiplies monthly rate by the number of estimated months of care plus fees.

     

     

     

    Child Care Aware of Northwest WA

    Serves Island, San Juan, Skagit, Snohomish, and Whatcom Counties.

    Opportunity Council

    Whatcom County
    1201 Cornwall Ave. Ste. 201
    Bellingham, WA 98225
    888-444-1862 ext. 1227

    Skagit County
    416 Main Street
    Mount Vernon, WA 98273
    360-305-0481

    Opportunity Council

    Snohomish County North
    3900 Broadway Street
    Everett, WA 98201
    360-739-8203

    Snohomish County South
    3400 188th St. SW, Suite 291
    Lynnwood, WA 98037
    360-739-8650

     

    C-RECC NW

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