FORMS

These forms are for clients applying for or currently receiving child care funding through the CCIS office. Please contact us if you are not sure which form(s) you need.

Documents on this page may be viewed online or printed with Adobe Acrobat Reader.

Class-Training Schedule Verification (CD 930)

The Class-Training Schedule Verification Form (CD930) must be completed if you are enrolled in a training and/or college program.
The form needs to be completed by an authorized representative of the educational organization you are attending.

Education Schedule Verification Form (CD924)

The Education Schedule Verification Form (CD924) should be completed if you are attending a full-time elementary, middle school, or high school program that upon completion will result in a diploma or GED.
The form must be completed and signed by an authorized school representative.

Employment Verification Form (CY925)

The Employment Verification Form (CY868) must be completed and signed by your employer to verify your employment status.

One form is needed for each job you may have as well as for each adult family member in the household.
Every adult family member must submit one of these forms for each job they hold.

Medical Assessment Form (CD878)

The Medical Assessment Form (CD878) must be completed if two parents reside in your household and one parent is disabled, or if you are in a single parent household and become disabled while receiving funding.

The disabled parent should complete the first page of the form and a physician must complete the second page.
In order to be eligible for funding, the parent’s condition must prohibit him or her from caring for the family’s children.

Application for Subsidized Child Care

To qualify for low income funding:

You must be a resident of Berks County.

Your child must be a U.S. citizen or a lawfully admitted alien.

You must meet income guidelines.

You must be employed at least 20 hours per week, or be a full-time elementary/junior/senior high school student, or be in a combination of work and training.

You must pay a weekly co-payment based on family household gross income.

Download an application:

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