State of Illinois Department of Human Services - Bureau of Child Care and Development CHILD CARE APPLICATION Parent/Guardian Name: KEEP FOR YOUR RECORDS The State of Illinois helps income eligible families pay for their child care services - 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Parent/Guardian Name at the top of each page. Ensure all information is filled out clearly in blue or black ink.
3. Complete Section I with your personal details, including your address, contact numbers, and date of birth. If applicable, provide your Social Security Number.
4. In Section II, provide information about the other parent or stepparent living in your home, if applicable.
5. Fill out Section III with family information, ensuring to include all children under age 21 and their immigration status.
6. In Section IV, detail your child care arrangements by listing the provider's name and registration number. Specify the usual schedule of hours for each child.
7. Complete Sections V through VIII regarding monthly income and certifications. Attach necessary documentation as specified in the form.
8. Review all sections for completeness before submitting your application to ensure no questions are left blank.

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