How to Apply for Child Care Assistance


Download Form in Multiple Languages Below:


Download Form in Multiple Languages Below:

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 Supporting Documents or Forms


  •  This form MUST be completed and be together with your child care application as it tells us what child care center you would like to enroll your child(ren) in, the type of provider, the service rates, and provider’s assurance/certification of their care.

  •  Complete this to establish a DOA Vendor Number to get paid.

  •  Complete this IF you do not have a check-stub or an employer does not provide check-stubs (ex. Mom-And-Pop Stores, etc.).

  •  Form is used to verify the business or organization you are employed with or work in and any other employment information.

  •  Complete this IF you are self-employed or own a business and earn income
  •  Download in Multiple Languages:

o Chuukese
o Yapese 
o Kosraean 

  •  Complete this IF you are unable to work due to a medical, physical, mental, or emotional problem or are an individual identified as a caretaker for someone who needs a full or part time caretaker.

  •  This form must be completed when a client would like to transfer their children to another day care or child care facility.

Example: Change of Residency (My family moved to another village and would like a day care closer to my home.)


  •  This form is used to authorize or allow someone (other than the applicant) to receive the child care certificate.

  •  Complete this form IF there are any changes to the applicant’s name, salary, household size, home address, child care provider/center, or any other changes.


  • Monitoring Reports (Inspection Reports) can be found in our Child Care Provider’s Directory in the “MORE DETAILS” tab
  • DEH (Department of Environmental Health) Health Inspection Reports for licensed child care providers can be found on their online database here.
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