Childcare Provider Request Form
The Triton Childcare Fund has expanded our current program to offer childcare subsides to be used at approved, licensed and accredited childcare centers. In an attempt to better serve our UMSL student parents, especially those who have online or hybrid courses, or practicum/internships/clinicals, we believe that this expansion will allow student parents the option to choose care at a center closer in proximity to their homes or one that better suits their families' needs.

Students must contact the preferred childcare facility to ensure licensure and accreditation, and to obtain information including rates and availability prior to completing this request form. In addition, students must contact childcare providers directly to register and enroll in care. Please note completion of this form does not guarantee approval or enrollment at another facility and the Triton Childcare Fund does not guarantee availability of openings with childcare providers.

After this form is submitted, the program coordinator will contact the listed childcare center to discuss details of the program and ensure willingness. If the center is approved the student will receive an award letter shortly after.  
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Student Name *
Student ID *
Child #1 name *
Child #2 name (if applicable)
Childcare Center Name *
Childcare Center Address *
Childcare Center Contact Number *
Childcare Center Director Name *
Anticipated childcare schedule ( ex. Monday, Wednesday, Friday full days).  Please note: the amount of hours/days per week that you will receive subsidy for is based on your course schedule, study time needed and your work schedule may also be considered. *
Childcare center weekly cost of care for your child(ren) based on anticipated childcare schedule from previous question. Please contact requested childcare facility to determine this amount based on the age of your child and the schedule you wish to have. *
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