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Child Care Fee Subsidy Application for Licensed Child Care

To apply for child care fee subsidy please complete and submit this form.

Once submitted you will receive a copy sent to you as a PDF attachment for your records. A copy will also be received in our office.

Applicants are required to have a confirmed space in licensed child care in order to apply for child care fee subsidy and must be a resident of Leeds and Grenville to be eligible.

Applicants will be contacted by telephone to review the application and set up an appointment with a case manager.

The information used on this application is used to determine an applicant's financial eligibility for child care fee subsidy.

Application does not guarantee eligibility.

A Child Care staff person will contact you within 5 working days to arrange an appointment.

If you have any questions or require assistance while completing this form, a Program Support would be happy to assist you. Contact 613-342-3840, extension 2351.

Start Date:

Licensed Child Care Operator

Section 1: Applicant Information

Applicant 1:

Applicant 1 - Relationship

Last Name:

First Name:

Previous Name (if applicable):

Date of Birth:

Marital Status

Email Address

Street Address

Apartment/Unit/Box No.:

City

Postal Code

Municipality

Contact Phone Number

Preferred language of communication

Best time to contact you by telephone, Monday to Friday, 8:00 a.m. to 4:00 p.m.

Section 2: Application History

Have you applied for child care fee subsidy with the United Counties of Leeds and Grenville in the past?

Is your child(ren) attending a licensed child care centre or an licensed home child care now?

If "yes", name of child care centres or licensed home child care agency - list all: