2018 Childcare Subsidy Form

New Employees: 

Complete within the first month following your date of hire.

Current Employees:

Complete within the first 30 days of returning to work following a qualifying event (i.e. childbirth or adoption) in 2018.

Is Child #1 entering first grade in Aug/Sept 2018?
(First and Last Name of Individual or Name of Organization)
Is Child #2 entering first grade in Aug/Sept 2018?
(First and Last Name of Individual or Name of Organization)

For more information, visit the childcare subsidy web page. If you require assistance with this form, please contact benefits@usfca.edu.