DELCO Child Care COVID Support
Application For Families

Applications Closed

Applications are currently closed. Please check back later in case they open in the future.

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. This is the only individual CCPN will be in contact with in regards to this application.

First Name

Last Name

Phone

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

Street

City

APT #

State

ZIP

Check this box ONLY if you are experiencing homelessness, live in a shelter, or transitional housing. If not, leave this box unchecked.

If you checked the box above that are experiencing homelessness: Please describe the way we can get information about your application and funding to you. (Include any relevant addresses, emails, phone numbers, names of contacts, and who they are in relation to you.)

Below, list all other persons (not including the person completing this application) age 18 or over who are in the household. For each person listed, include: First and last name, email, phone

PART 2: Family/Children Information

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

Total # of adults age 18 or older in the household.

Total # of children in the household who need funding.

Total # of children in the household who do NOT need funding.

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

Child first and last name
Child date of birth
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
Child ethnicity (please use one of the following US Census terms):
- Hispanic or Latino
- Not Hispanic or Latino
Child's relationship to the parent/caretaker on this application.
List each individual day of the week child is attending ECE program. (A maximum of 5 days per week can be funded.)

Type Children Info here:

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.

ECE Program Name

Name of Director/Owner

Street

City

Suite #

State

ZIP

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.

Type additional ECE Program info here:

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. We must receive a copy of the document itself, not an envelope containing it. Documentation must be recent and must not be expired. The text on the document must be clearly visible. The address must match the address information submitted on this application. If you checked the box that you are experiencing homelessness, skip this part.

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 copy of the Fee Agreement is NOT a receipt of payment for child care services. You can view an example of a Fee Agreement on ccpnpa.org/covid-support. The Fee Agreement must have the names of the child(ren) and days of week of care. 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.

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 copy of the documentation must have the name of an adult listed on this application. Must include a copy of the 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.

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 of the following sources of income then you are not eligible to use the income attestation and you must submit the relevant documents in Section 4C: wages, contractor work, disability compensation, worker's compensation, child support, alimony, etc.

Download Income Attestation

PART 5: Additional Questions

Check the reasons for needing child care. Check all that apply. At least one must be checked.

Parent/guardian seeking employment

Parent/guardian change in employment status (reduced salary, reduced hours)

Parent/guardian enrolling in school

Parent/guardian attending school

Child(ren) are wait listed for CCW (CCIS)

Illness or death of a primary care giver

Foster Care / Adoption

Grandparent is the primary caregiver of grandchild(ren)

Other (explain below)

If "Other", explain below:

Will this funding allow you to (at least one must be checked)...

Funding allows parent/guardian to return to work.

Funding allows parent/guardian to continue to work.

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:

I attest that I live in Delaware County, PA.
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.
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.
I attest that the children on this application are between the ages 0 to 13 years old at the time of applying.
I attest that the children on this application are not receiving a subsidy through CCW/CCIS or CAO.
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.
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
I agree that if there are any changes to a child's schedule while the child is being funded, then I will notify CCPN immediately by submitting a Request for Change form. I understand that no changes to the original funding terms will go into effect until CCPN can approve them and issue the new terms of funding and when the new terms begin. I understand that no funding will be backdated for changes made to care before this form was approved. I understand that not all requests may be able to be accommodated.
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.
I understand that by accepting this funding, any information I submitted may be verified as part of program integrity and fiscal accountability measures.

By checking this box, providing my digital signature, and submitting the attestation form, I attest that the information I provide about my application, to the best of my knowledge, is accurate and true. I understand that I may be referred to the Office of State Inspector General (OSIG) for criminal prosecution if I am suspected of engaging in fraud, or both. The referral to OSIG may result in a criminal fine. CCPN shall not be liable or bound in any manner by express or implied promises, statements, representations, or information that contradict this attestation. I understand information on this page may be relied upon to make payments from Federal funds, and any false information, statements, or documents or the concealment of material facts may be prosecuted under applicable Federal and State laws.

Signature

Date

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.

Applications Closed

Applications are currently closed. Please check back later in case they open in the future.

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.

DELCO Child Care COVID Support Application For Families

Applications Closed

Before Applying

PART 1: Parent/Guardian Information

PART 2: Family/Children Information

PART 3: ECE Program Information

PART 4: Supporting Documents

4A. Proof Of Address

4B. Proof of Fee Agreement

4C. Proof of Income

PART 5: Additional Questions

PART 6: Attestation

PART 7: Submit

Applications Closed

DELCO Child Care COVID Support
Application For Families