If you selected "white" or "Black or African American" Skip to section 2 now
For Families Temporarily living with realatives or others, do not list hosts.
For Families with two households when there is joint custody with no primiary parent and no child support:
STAFF WILL USE THIS INFORMATION TO CALCULATE FAMILY SIZE TO DETERMINE STATE MEDIAN INCOME (SMI)
Answer "NO" for a person age 19 or older who has earned or unearned income that covers ore thanhalf of their expenses. Answer "YES" if the ECEAP child's parents pay more than half of their expenses
FOR STAFF USE ONLY
Family size for SMI chart: ___________________________________________
For children in foster care, kinship, or adopted after foster/kinship care or living in an orphanage in another country, count family size as 1. For all others, count peopel with "YES" for both questions above.
If child only has one parent/guardian, skip to section 5 now
If child has two parents/guardians answer these questions to determine which parent's income is counted for ECEAP eligibility.
If one parent has primary custody, skip to section 5 now
If neither parent/guardian has primary custody, ECEAP will count the income from the legal parent/guardian for each household
Do not include their spouses.
Do not count the same hours in more than one category. For example:
School/ Job Training
For children in foster care, kinship care, or adopted after kinship care:
For children in foster care, kinship care, or adopted after kinship care,
skip to Section 10
For children NOT in foster care, kinship care, or adopted after kinship care
If yes, skip to Section 10
ECEAP serves children with behavior issues.
Checking "yes" will not exclude this child
I promise that the information on this form is true and correct. I have reported all my income and family size, as required by ECEAP. If I knowingly provide false information, I understand my family may be unable to continue ECEAP services. Additionally, I may have to repay the amount spent on my child's ECEAP.
I understand that information from this application is entered in the Early Learning Management System (ELMS) operated by the Department of Children, Youth, and Families (DCYF). DCYF is committed to protecting confidential and personal information that could identify a child or family. No information related to immigration status is entered into ELMS or shared with state or federal agencies. Information in ELMS may be used for:
I certify that, to the best of my knowledge, the information on this form is true and correct. I viewed and verified documentation establishing this child's eligibility for ECEAP. I understand that ECEAP Performance Standards require that i notify the Department of Children, Youth, and Families if I suspect any fraudulent use of ECEAP funds including, but not limited to, and employee intentionally entering a deceptive or false information into ELMS regarding: