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Subsidized Childcare Application

Parent Information
Type of Parent
In Home?
Are you working?
Are you a student?
Which location do you prefer?
Child Information
Additional Children
Family Information
Please check all sources of income that apply:
Do you receive the Federal Pell Grant?
I understand that it is my responsibility to notify AHC Children's Center Lab School of any changes to the information on this application. Failure to report changes may be cause for removal of this application from the eligibility list. I agree that the information provided above is accurate and may be shared with other agencies in helping me receive childcare services. *
I understand that this application will not be considered complete until I turn in my last 30 days of income, birth certificates for all children in my family, immunizations for the child(ren) I want to enroll and a copy of my school schedule, if applicable. I must bring all documentation to the children's center located on the Santa Maria Campus in Building I. *

Download PDF version of the Application

Descarge la solicitud Español

You also can fax the completed PDF application to: 1-805-922-6662 
or if you have any questions please call 1-805-922-6966 Ext. 3569