Laurie R. Gill
Read the application carefully and answer each question completely.
Refer to the
Frequently Asked Questions
section for more information.
If you have any
about completing this application,
Online Child Care Search
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 definition of "homeless"
according to the McKinney-Vento Act. Review
the definition of "homeless"
to help in answering the following questions.
Any citizen in the State of South Dakota
who meets the voter registration requirements
and applies for public assistance
must be provided the opportunity
to register to vote.
IF YOU DO NOT CHECK EITHER BOX,
YOU WILL BE CONSIDERED TO HAVE DECIDED NOT
TO REGISTER TO VOTE AT THIS TIME.
(failure to check either box
is deemed a declination to register
for purposes of
receiving assistance in registration
but is not deemed a written declination to receive an application.
If you do not check either box,
you will be provided a voter registration form
that you may complete at your convenience.)
You must include an official 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 the last 30 days of payments)
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.