Financial Aid Child Care Allowance 2020-2021
Name: Student ID#:
You are requesting an adjustment to your cost of education. The actual cost for child care will be added to the basic
cost of education only if the child care is fully documented. If your children are of age to attend public school,
private school education will not be considered. If you are requesting child care funds outside of normal business
hours, please provide a written statement of explanation.
Please have your child care provider complete ALL of the information below.
Child’s Full Name Age
Cost per
# of Months in child care for the
20-21 aid year (Summer/Fall/Spring)
Children should be 12 years of age or under unless there is an extenuating circumstance.
Child Care Provider Name:
Phone Number:
Name of individual paying for the child care of the above listed child(ren):
Child Care Provider Printed Name Child Care Provider Signature
All of the information provided is true and complete
to the best of my knowledge. If requested by an
authorized official, I agree to provide additional documentation necessary to verify my request. I certify
that I have read and understand the requirements above. I certify that I am the person paying for
the child care.
Student’s signature Date
Print Completed Form
Submit Completed Form
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