THIS FORM IS ONLY FOR PLAN YEAR 2013.
NEWLY ELIGIBLE EMPLOYEES (NEW HIRES OR NEW BABIES) ARE ELIGIBLE TO APPLY WITHIN 30 DAYS OF THE QUALIFYING EVENT.
PLEASE COMPLETE THE FORM BELOW TO APPLY FOR 2013 CHILDCARE SUBSIDY.
Employee First Name: Home Phone Number:
Employee Last Name: USF Phone Extension:
USF ID Number*: Date Returning to Work (MM/DD/YY)
USF Email Address:
Application is not complete until you have clicked "Submit Form" and received the confirmation message.
*If you don’t know your USF ID number, please follow these steps:
If you require assistance with this form, please contact firstname.lastname@example.org.
Expecting a baby in 2013? No need to apply for the Childcare Subsidy now. You will be eligible to complete the application within the first 30 days of your baby's life. For more information, you can consult our New Parent Packet.