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Testimonials

Many thanks for sending me the outstanding (!) array of training sessions that
are upcoming at 4-C. I was really excited about thinking how lucky child care professionals in Louisville are to have access to your services. I forwarded your email to a friend of ours who works for a center in eastern Louisville.

Fitzpatrick

Child Care Subsidy Inquiry

Personal Info

What County do you live in?(required)
(If your county is not listed, you are not eligible to apply for this service with 4-C. To find the agency who serves your area, please call 1-800-424-2246 or visit www.childcareaware.org
First Name(required)
Last Name(required)
Last 4 Digits of SS#(required)
Street Address(required)
City(required)
State(required)
Zip Code(required)
Home Phone
Other Phone
Email Address(valid email required)
Number of children in your household for whom your household has custody(required)
Date of birth of all children in household (mm/dd/yy)(required)

Employment Information

Are you currently employed?
Yes No
Employer Name
Work Phone (Include extension)
How many hour per week do you work?
How much do you make per hour?
(Salaried, commissioned or other types of employees should enter their average monthly income)
SECOND JOB (If applicable)
Employer Name
Work Phone (Include extension)
How many hour per week do you work?
How much do you make per hour?
(Salaried, commissioned or other types of employees should enter their average monthly income)

School Information

Do you attend school?
Yes No
If yes, and you participate in an internship, practicum or student teaching program, please indicate the number of program hours per week:

Other Parent of Spouse's Information

Is your child(ren)'s other parent or your spouse living in your household?
Yes No
If "no", go to Other Income section
First Name
Last Name
Is the other Parent Currently Employed?
Yes No

Other Parent/Spouse Employment

Other Parent Employer Name
Other Parent Work Phone Number (Include extension)
How many hours per week does the other parent work?
How much does the other parent make per hour?
(Salaried, commissioned or other types of employees should enter their average monthly income)
OTHER PARENT SECOND JOB (If applicable)
Other Parent Employer Name
Other Parent Work Phone Number (Include extension)
How many hours per week does the other parent work?
How much does the other parent make per hour?
(Salaried, commissioned or other types of employees should enter their average monthly income)

Other Parent School Information

Does the other parent attend school?
Yes No
If yes, and you participate in an internship, practicum or student teaching program, please indicate the number of program hours per week:

Other Income

CHILD SUPPORT
Do you or the other parent in household receive child support?
Yes No
If yes, enter the average amount received per month
Do you or the other parent in household pay child support?
Yes No
If yes, enter the average amount paid per month
SSI
If any members of your household receive SSI, please indicate the monthly amount
You
Other Parent
Children
KTAP or TANF
Do you or the other parent receive KTAP or TANF?
Yes No
Do any of the children in the household receive KTAP, TANF, SSI, disability, etc. ?
Yes No
If yes, enter monthly amount
ADDITIONAL INCOME
Please enter any additional income your household receives
Monthly Amount
Type of Income
Household member receiving

MORE INFORMATION

Additional comments or information

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