2012 Childcare Subsidy Application

THIS FORM IS ONLY FOR PLAN YEAR 2012.

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 2012 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:

Employee Last Name:

USF ID Number*:

USF Email Address:

Child Information
	Child #1	Child #2	Child #3
First Name
Last Name
Year of Birth (YYYY)
Is Child entering 1st grade in 2012? (Yes/No)

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.

For more information about the Childcare Subsidy, click here.

Expecting a baby in 2012? 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.