Pre-Qualification for Maryland Child Care Scholarship

Pre-Qualification Form

For Summer Financial Assistance & Fall Maryland Child Care Scholarship
Boys & Girls Clubs of Harford & Cecil Counties continue to stay committed to the youth and families in our communities. We are currently offering limited financial assistance for the BGC Summer Program.

We have also begun the training and processes needed to become fully licensed by the state for child care. Once licensed, we will be able to provide full day care to families and accept the MD state scholarships. We anticipate being able to begin this program in the fall.

Please complete this quick survey to find out if you qualify for the summer Financial Assistance Program or the fall Maryland Child Care Scholarship.
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Preferred Club?

Aberdeen Bel Air Edgewood Havre de Grace North East Conowingo
Do you already receive Free and Reduced Priced Meals (FARMS)? *

Yes No
Do you already receive Maryland Child Care Scholarship? *

Yes No
Are you a Temporary Cash Assistance (TSA) or Supplemental Security Income (SSI) applicant or recipient? *

Yes No
Are both parents living in the same household? *

Yes No
Are you a Maryland resident who is working/employed OR in an approved training program OR attending school? (For families where both parents live within the same household both parents MUST meet all eligibility requirements.) *

Yes No
Do you fall within CCS income guidelines? (Select the option that best fits your family size and income. If you do not fit in any of the fields, please select 'none of the above') *

Family of 2, Max Annual Income $42,637 Family of 3, Max Annual Income $60,081 Family of 4, Max Annual Income $71,525 Family of 5, Max Annual Income $82,969 Family of 6, Max Annual Income $94,413 Family of 7, Max Annual Income $96,558 Family of 8, Max Annual Income $98,704 Family of 9, Max Annual Income $100,850 Family of 10, Max Annual Income $102,996 None of the above
Are you willing to have your child immunized to Maryland state standards OR provide documentation supporting Exemption from Immunization? *

Yes No
You may qualify for the Maryland Child Care Scholarship!

Click the submit button below for instructions on the next steps. If you are interested in summer child care, we will use this completed survey and let you know if you are eligible for the summer financial assistance program.
You may not qualify for the Maryland Child Care Scholarship

Click the submit button below for instructions on the next steps. If you have any scholarship questions or believe you do qualify, please contact Rachel Boucher, Director of School Based Programs, at rboucher@bgcharfordcecil.org.
Do you qualify?

Yes No
Should be Empty:

Pre-Qualification Form

You may qualify for the Maryland Child Care Scholarship!

You may not qualify for the Maryland Child Care Scholarship