THIS FORM IS ONLY FOR OPEN ENROLLMENT 2014
NEWLY ELIGIBLE EMPLOYEES ( NEW HIRES OR NEW BABIES ) ARE ELIGIBLE TO APPLY WITHIN 30 DAYS OF THE QUALIFYING EVENT.
Employee First Name: Home Phone Number:
Employee Last Name: USF Phone Extension:
USF ID Number:
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 2014? No need to apply for the childcare subsidy now. You will be eligible to complete the application within the first 30 day's of your baby's life. For more information, you can consult our new parent packet.