FORMS & PUBLICATIONS – CCIS

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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.

 
>> Download the Class-Training Schedule Verification (CD 930)

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.

 
>> Download the Education Schedule Verification Form (CD924)

 EMPLOYMENT VERIFICATION FORM (EVF 2/2105)

The Employment Verification Form 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.

 
>> Download an Employment Verification Form (2016).

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.

 
>> Download the Medical Assessment Form (CD878).

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 and print an applicationEnglish | Español

PUBLICATIONS

CCIS of BERKS COUNTY BROCHURE   English | Español

KEYSTONE STARS BROCHURE

>> Click here to learn about quality child care and the Keystone STARS program.

>> Oprima aqui para aprender sobre el cuido de nino con alta calidad y el programa de Keystone STARS.

BE YOUR CHILD’S CHAMPION

Discover ways you can be a champion for your child. Click here for a printable copy.


Do you need more information?

contact:
phone – 610-987-CCIS(2247) or 1-800-257-3038; fax – 610-987-8428; e-mail – ccis@berksiu.org
CCIS representatives are available Monday through Friday, 8 a.m. – 5 p.m.
Se habla Español.