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2013 Childcare Subsidy Application

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.

NOTE: Internet Explorer does not support this form submission. Please complete this form in a Firefox, Safari or Chrome web browser.

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:   

 

Child Information
Child #1 Child #2 Child #3
First Name
Last Name
Date of Birth (MM/DD/YY)
Is Child entering 1st grade in 2013? (Yes/No)
Date Childcare will begin (MM/DD/YY)    

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:  

  1. Go to site http://connect.usfca.edu
  2. At the bottom of the green box on the top left, click on "Look-up username or USF ID".
  3. Look to the bottom of the text and click on "USF ID Number Lookup".
  4. Input USF username and password to have your ID listed.

If you require assistance with this form, please contact benefits@usfca.edu.

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.