DELCO Child Care COVID Support
Application For Families

Before Applying

  • Make sure you have read the Eligibility Guidelines.
  • Have the following supporting documents ready to upload in an image (JPG, PNG, etc.) file format:
    1. Proof of Address
    2. Proof of Fee Agreement
    3. Proof of Income
  • If you leave this page before the application is successfully submitted, you will lose all changes you've made to the application.
PART 1: Parent/Guardian Information

Type the information for the parent/guardian responsible for completing this application.

Type your home address in the boxes below. Families must live in Delaware County, PA.

PART 2: Family/Children Information

Write the information about the family and children being funded. Complete all sections even if the number is zero.

Below, list the following information for each child who needs funding, include:

  1. Child first and last name

  2. Child date of birth

  3. Child race (please use one or more of the following US Census terms):

    • White

    • Black or African American

    • American Indian or Alaska Native

    • Asian

    • Native Hawaiian or Other Pacific Islander

  4. Child ethnicity (please use one of the following US Census terms):

    • Hispanic or Latino

    • Not Hispanic or Latino​

  5. Child's relationship to the parent/caretaker on this application.

  6. List each individual day of the week child is attending ECE program. (You can list a maximum of 5 days per week)

PART 3: ECE Program Information

Please note: Child(ren) must already have a Fee Agreement with an approved DHS licensed ECE Program in Delaware County before applying.

If there is any other information about the ECE Program or your child(ren)'s schedule that is not reflected on this application, please type as much detail below. Examples include if children on this application attend different ECE Programs, or if there is something about their schedule that is irregular which is not reflected on this application.

PART 4: Supporting Documents

You will need to upload 3 copies of supporting documents. One for Proof of Address, one for Proof of Fee Agreement, and one for Proof of Income. A description of the types of each proof that are acceptable, and how to upload them are below. Only recent documentation will be accepted.

4A. Proof Of Address

Please provide a copy of one of the following: lease, utility bill, deed, rental agreement, state photo ID, driver's license, or voter's registration card. An envelope, even if it contains one of these documents, will not be accepted. Documentation must be recent and must not be expired. The text on the document must be clearly visible. The name and address on the documentation must match the name and address submitted on this application. If you checked the box that you are experiencing homelessness, skip this question.

All files must be image files (JPG, PNG, etc.) You can convert documents to images for free at this (third party) website: PDFtoImage . If you are uploading multiple pages, make sure they are scanned into one document.

Upload Proof of Address
4B. Proof of Fee Agreement

Before applying, families must have a Fee Agreement with one of the approved ECE Programs that are participating in this program. A Fee Agreement is NOT a receipt of payment for child care services. You can view an example of a Fee Agreement here. If you do not have a Fee Agreement with an ECE Program that has been approved, inquire with your preferred program if they are participating in this support.

 

The Fee Agreement must have the names of the child(ren) and days of week of care listed.  All information on your application must match exactly what is on the Fee Agreement.

All files must be image files (JPG, PNG, etc.) You can convert documents to images for free at this (third party) website: PDFtoImage . If you are uploading multiple pages, make sure they are scanned into one document.

Upload Fee Agreement
4C. Proof of Income

The income from the documentation you upload must be equal to the amount you write in the box below. Any discrepancies will delay verification of your application. Each documentation must have the name of an adult listed on this application. Must include proofs for ALL sources of income for every member of the household who receives a form of income. Examples include: Pay stubs of wages, unemployment, child support, alimony, etc. Only recent documents will be accepted.

For example: A one week pay stub of $500 before taxes x 52 weeks per year = $26,000 total yearly income before taxes.

 

All files must be image files (JPG, PNG, etc.) You can convert documents to images for free at this (third party) website: PDFtoImage . If you are uploading multiple pages, make sure they are scanned into one document.

Upload Proof of Income

ONLY If you have NO INCOME to report: You must download the "Income Attestation" below, sign, and date it, and upload it in in the section for "Upload Proof of Income". If you receive any form of income, you cannot use the form below, and must upload documents for that income.

PART 5: Additional Questions
Check the reasons for needing child care. Check all that apply. At least one must be checked.
Will this funding allow you to (at least one must be checked)...
PART 6: Attestation

Check the box to the left of the attestation below, and sign the attestation by typing your name. An attestation is a sworn statement of fact. By signing this attestation, you are saying that the information you entered in this form is true. The attestation is the legal way to swear that your statements are fact. The person submitting this application should sign and date this application. Your signature validates the information you entered into the form.

By submitting this form, I attest to and will comply with the following:

  1. I attest that I live in Delaware County, PA.

  2. I attest that I have not previously nor currently received any funding for this program since February 2022. I understand that applications from families whose children are already funded or were previously funded will not be approved.

  3. I attest that I have a Fee Agreement with a DHS licensed ECE Program located in Delaware County, PA that has been approved to receive these funds.

  4. I attest that the children on this application are between the ages 0 to 13 years old at the time of applying.

  5. I attest that the children on this application are not receiving a subsidy through CCW/CCIS or CAO.

  6. I attest that the all supporting documents uploaded with this application contain true and complete information to the best of my knowledge, and no information or documents that could be relevant to this application have been withheld.

  7. I attest that my gross annual income is based on all available information to me, and that is falls within the guidelines per family size below:

    • Family size of 2 = $74,220 maximum gross yearly income

    • Family size of 3 = $83,520 maximum gross yearly income

    • Family size of 4 = $92,760 maximum gross yearly income

    • Family size of 5 = $100,200 maximum gross yearly income

    • Family size of 6 = $107,640 maximum gross yearly income

    • Family size of 7 = $115,080 maximum gross yearly income

  8. I agree that if there are any changes to a child's schedule I will notify CCPN immediately by completing a Request for Change form, and I understand that no changes to the original application or funding will go into effect until CCPN can approve them. I understand that no funding will be backdated for changes made to care before this form was approved.

  9. I agree that if I would like to request any changes to the funding agreement for approved children, I must complete a Request for Change Form. I understand that no changes that are made to approved child(ren)’s care that are done before any approved funding changes go into effect will be funded. I understand that I will be responsible for any additional costs incurred for changes made to care before their approved Effective Date.

  10. I agree that if any information about my family size, income, children’s enrollment in an ECE Program, or anything else that may affect eligibility for this program changes, that I will notify CCPN as soon as possible.

  11. I understand that by accepting this funding, any information I submitted may be verified as part of program integrity and fiscal accountability measures.

PART 7: Submit

Please scroll up and review the application and make sure every box, checkbox, and upload button has been complete. Click "Submit" below when ready. If the application is submitted successfully, you will be taken to a confirmation page automatically.

If the application was not submitted, you will see a message below the submit button. Incomplete boxes and buttons on the application will also turn red. Make the corrections necessary then click "Submit" again.

​The application is incomplete and has not been submitted yet. Do not close this page or you will lose any changes you've made to the application.

Any boxes, checkboxes, or upload fields that are required will turn red if not complete. Scroll up and make sure any incomplete red boxes are complete.

Click "Submit" when you have made your corrections. If you continue to get an error, you can complete a Paper Application.

You will be taken to a confirmation page if it submits successfully.