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Childcare Substitute Inquiry Form
This form is for individuals interested in receiving scholarship funding for costs associated with becoming a childcare substitute.
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* Indicates required question
Name
*
Please enter the first and last name of the prospective childcare substitute.
Your answer
Contact Information
*
Please enter the email, telephone number and mailing address of the prospective childcare substitute.
Your answer
Childcare Provider Association
If you have already identified an individual provider or childcare facility to substitute for, please enter the name of that provider and/or facility.
Your answer
Multiple Providers?
*
Would you consider being put on a sub list to be accessed by area childcare providers/facilities?
Yes. I would consider being put on a sub list to be accessed by area childcare providers.
No. I am only interested in substituting for a specific provider/facility.
Coverage Area
If you would consider being included on a sublist for providers/facilities what communities are you interested serving?
Your answer
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