I understand that...
the statements made in thi
s application must be and are to the best of my knowledge, true
all information provided will be verified.
CCP staff will be in contact with child care program listed above about your account & past due balance.
By signing/typing my name here, I agree that I have been unable to pay household bills and that my household income was negatively impacted by COVID-19. I also acknowledge that filling out this form does not guarantee I will receive assistance. I hereby certify that the information provided is complete and accurate to the best of my knowledge. If I report any inaccurate or incomplete information my case benefit may change. I give permission to Western Dairyland CAP to inquire about my account with my child care program and share that information necessary in order for them to complete my bill pay assistance.