Request for Exempt Provider Orientation
Thank you for contacting Community Connection for Child Care's Exempt Provider Support Department.  Exempt Providers are considered family members, friends or neighbors to a parent receiving child care subsidies from Community Connection for Child Care.  If you will be providing child care for an eligible Community Connection for Child Care family, you are required to complete the Exempt Provider Orientation process.  Requesting an Exempt Provider Orientation is the first step in the approval process.  

Please complete the questionnaire below by answering EVERY question.  A staff member will then contact you, review the program requirements and discuss your next steps.  If you have questions specifically regarding the Exempt Provider Orientation process, please email at  provider@kern.org
*** The information provided in the following questionnaire is confidential and will only be viewed by Community Connection for Child Care staff in an effort to onboard you as a new child care provider.
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Email *
Provider's Last Name *
Provider's First Name *
Street Address *
Apartment Number
City *
State *
Phone Number *
Have you ever been paid to provide child care by Community Connection for Child Care? *
Enter your Valid State ID or Driver's License Number below (The first and last names on your ID and Social Security card MUST match EXACTLY.  If the names do not match, one must be officially corrected before you can be paid by our agency.)   *
Enter your Social Security Number below (An original social security card will be required.  The first and last names on your ID and Social Security card MUST match EXACTLY.  If the names do not match, one must be officially corrected before you can be paid by our agency.) *
Do you have results from a current NEGATIVE TB test taken within the last 12 months? *
Parent's Last Name *
Parent's First Name *
How many children will you be providing care for? *
Are YOU related to the PARENT? If so, how are you related? *
Required
Are YOU related to all the CHILD(REN)? If so, how are you related? *
Required
Comments or Questions...
A copy of your responses will be emailed to the address you provided.
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