Childcare Grant Application - Indiana Association for Home and Hospice Care

Childcare Grant Application

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, disability, age, sexual orientation, gender identity, national origin, veteran status, or genetic information. The Indiana Association for Home and Hospice Care (IAHHC) is committed to providing access, equal opportunity and reasonable accommodation for individuals with disabilities in employment, its services, programs, and activities. To request reasonable accommodation, contact Tim Scully, Director of Workforce Development at Tim@iahhc.org.

Childcare organiations must comply with Title VI of the Civil Rights Act of 1964, Title IX of the Education Amendments of 1972, Section 504 of the Rehabilition Act of 1973, the Age Discrimination Act of 1975, and any provisions or regulations required by the implementing Federal Agency providing the funds.

Fields marked with an * are required.

First Name *

Last Name *

Email *

Agency Name (Your Employer) *

Your agency must be a member of the Indiana Association for Home and Hospiace Care (IAHHC). Go to https://members.iahhc.org/member-directory to see if your employer is a member.

Agency City *

Employment Start Date *

You must be employed for a minimum of 60 days at your agency to be eligible

Dependent Name *

If you have more than 1 dependent in childcare, please submit a new application for each dependent.

Childcare Agency Name *

Childcare providers must maintain status as a licensed, regulated, or registered child care provider and remain in good standing with the Indiana Office of Early Childhood and Out of School Learning. (If you are unsure if you're child care provider is licensed, regulated, or a registered childcare provider, please submit an application and we will verify that your childcare provider is eligible).

Childcare Agency Address *

Childcare Agency City *

Childcare Phone Number *

Childcare Agency Email

My child/dependent is enrolled in:

Full Time Childcare

Part Time Childcare

After School Childcare

Summer Childcare

Is your child currently enrolled and attending at this location? *

Yes

Submitted By

Leave blank if completing this form for yourself

Please verify that you have checked the “I'm not a robot” checkbox.