Read the application carefully and answer each question completely. Refer to the
Frequently Asked Questions
section for more information.
If you have any questions about completing this application, you can call (605) 773-4766, toll-free 1-800-227-3020, or email
If you need to locate a registered or licensed child care provider,
List everyone who lives in your home, including roomers,
boarders, friends and relatives.
If your current address is a temporary living arrangement, you may meet the defintion
of "homeless" according to the McKinney-Vento Act. Review
the definition of "homeless"
to help in answering the following questions.
You must include an offical school schedule for each adult family member attending school
You must attach proof of income for all current employment:
Please fill out the following information for each job.
(If you do not receive child support payments through the SD Division of Child Support, you must
provide verification of payments received for the six months prior to the date of this application.)
List any other sources of income you have, including work-study, interest, pensions, retirement,
TANF, Social Security, Veteran's Benefits, periodic/lease income, boarder/roomer rent, workers
compensation or unemployment.
(If no, provide proof of payment - a cancelled check or a receipt from the clerk of courts)
Fill out the following information for each child in child care.
If you have more than one child care provider, please fill out the following information for each of them.