Lower Cape Emergency Scholarship Application

Lower Cape Emergency Child Care Fund Application

This fund provides short-term emergency child care funds for children from infancy through school-age, living in the eight Lower and Outer Cape towns of Brewster, Chatham, Eastham, Harwich, Orleans, Provincetown, Truro and Wellfleet. Its purpose is to enable the family to put a plan into place for sustainable child care,

The Lower Cape Emergency Child Care Fund was created with money awarded in 1998 by the Local Mission Committee of the Federated Church of Orleans, which has awarded additional funding each year since then. The fund is also supported by other organizations, churches, businesses and individuals in the community.

Applications are reviewd monthly with awards considered based on the goals and resources of the fund. Applicants will be notified of the results as soon as their application has been reviewed. Any funds awarded will be paid directly to the childcare provider(s) named in the application. Notification and payment will be handled by Cape Cod Children's Place.

Please fill out this application and submit it to: Cape Cod Children's Place, PO Box 1935, 10 Ballwic Rd., N. Eastham, MA 02651 - phone 508-240-3310, fax 508-240-2352

APPLICATION

Name of applicant (parent/guardian):____________________________________________________________

Child's name:________________________________________Age/grade enrolled:_______________________

Mailing/residential address:____________________________________________________________________

Home phone no.______________________________cell no._______________________________________

Number of adults in home:___________________Number and ages of children:___________________________

Adult(s) employed____________________________________________________________________

Your household income last month:_____________________________________________________

Name of childcare provider/program to be paid with these funds:___________________________________________

Address & phone # of childcare provider:____________________________________________________________

Is this provider licensed?_________ Relationship (if any) of provider to applicant:______________________________

What are your total monthly child care expenses:__________________ for how many children:___________________

Please list separately the child care expenses and needs for each child in your household:

Name:____________________________Age___________Days/wk:______________Fee/wk/mo.______________

What is the balance at this time of your childcare tuition bill:___________________________________________

What child care fee(s) can you afford at this time:_________________________________

How long do you expect to need this assistance paying child care:_________________________________________

Have you applied to other sources for help:_________________ If yes, where: _____________________________
Lower Cape Coutreach Council______________Church________________Town________________Other (please specify)_____________________________________________________________________________________

Is there someone who would advocate for your circumstances: ______________

Name & phone #:_____________________________________________________________________________

Please list your reasons for applying for these funds at this time: (use additional paper if required)___________________
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Is there anything else you would like the committee to know about your situation:_____________________________
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I hereby verify that the information provided above is correct.

Your signature:___________________________________________Date:________________________________

Referring agency signature (if applicable):____________________________________________________________

Please fill out all information in this application. You are encouraged to provide as much supporting information as possible, both specific information about your circumstances and copies of relevant financial documentation. Review of your application will be preceded by conversations with you and with your childcare provider. Submit completed application to: Cape Cod Children's Place, PO Box 1935, N. Eastham, MA 02651 phone- 508-240-3310; fax- 508-240-2352

This fund is administered by Cape Cod Children's Place, Inc. and supported by community donations. Applications will be reviewed by a committee of community volunteers. Awards will be made based on applicant's' needs and availability of funds.