HR Childcare Subsidy Form 2021 | myUSF

2021 Childcare Subsidy Form

Employee's Information

Employee's First Name

Employee's Last Name

Employee's CWID

Employee's Title

Home/Cell Phone Number

USF Phone Extension

USF Email Address

Employee's Department

Date of Hire

Return to Work Date

Child's Information

Child(ren)'s Information

Child

Child #1

First Name

Last Name

Date of Birth

Age for child

Is child #1 entering first grade in Aug/Sept 2021?

Yes

No

Childcare Provider for child

(First and Last Name of Individual or Name of Organization)

Start Date of Childcare child 1

Childcare Provider's Address for child

Child

Child #2

First Name

Last Name

Date of Birth

Age for child

Is child #2 entering first grade in Aug/Sept 2021?

Yes

No

Childcare Provider for child

(First and Last Name of Individual or Name of Organization)

Start Date of Childcare child 2

Childcare Provider's Address for child