Provider Reimbursement

CLAIM YOUR HEALTH AND SAFETY REIMBURSEMENT SCHOLARSHIP

Connections for Children (CFC) has received a grant from the California Department of Social Services, Child Development Division to administer Health and Safety Scholarships to early childhood educators.
*IMPORTANT--Please note:

These scholarships may be used by
- Licensed center staff
- Licensed family child care providers
- License-exempt child care providers
Qualifications for training reimbursement:
- Completed Pediatric CPR, First Aid (min. 8 hours) or Preventative Health & Safety
- Certification of training must indicate a completion date within July 1, 2024 - June 30, 2025
- Training from an approved Emergency Medical Services Authority (EMSA) Institution or trainer is required
- Individual must provide care in Connections for Children's service area
PLEASE SUBMIT THE FOLLOWING DOCUMENTATION ALONG WITH THIS APPLICATION:
- Certification of training (copy of cards copied front and back or copy of your certificate)
- Proof of amount paid (copy of cashed check copied front and back or copy of your receipt, must indicate "PAID" on receipt)
- Check will be made to person whose name appears on the receipt***
ONLY COMPLETE APPLICATIONS WILL BE REVIEWED.

Scholarship Limits:
- 3 Staff per Licensed Facility
- Maximum scholarship amount up to $150.00 per year, person
Reimbursement scholarships are available on a
first come basis AND only as long as funding is available

LIST OF EMSA INSTITUTIONS:
- American Red Cross
- American Heart Association
- Or any other EMSA certified trainer
Questions? Contact:

Itzel Labra at 310-452-3325 Ext. 275 or Itzell@cfc-ca.org
Facility Name*
Type of Provider (mark one)*

Family Child Care ProviderChild Care CenterLicense-Exempt Provider
Address of Facility*
Street Address (including unit # if applicable), City, and Zip code
Participant #1: First & Last Name*
Participant #1: Phone Number*
Participant #1: Email Address*
Participant #1: Mailing Address*
Street Address (including unit # if applicable), City, and Zip code
Training Information:*
COST FOR PARTICIPANT#1
Participant #2: First & Last Name
Participant #2: Phone Number
Participant #2: Email Address
Participant #2: Mailing Address
Street Address (including unit # if applicable), City, and Zip code
Training Information:
COST FOR PARTICIPANT#2
Participant #3: First & Last Name
Participant #3: Phone Number
Participant #3: Email Address
Participant #3: Mailing Address
Street Address (including unit # if applicable), City, and Zip code
Training Information:
COST FOR PARTICIPANT#3
File: Proof of amount paid (i.e. copy of cashed check or copy of your receipt). All proof must indicate "PAID".*

Upload a File
Proof of payment MUST show the amount paid PER participant. If needed, you may upload multiple files here. Cancelof
File: Copy of training completion certificate(s)*

Upload a File
*If needed, you may upload multiple files here. Cancelof
I have enclosed EACH of the following:*

Training completed between July 1, 2024-June 30, 2025A copy of receipt that shows amount paid PER participantA copy of EACH participant's certificate of completion or certification card
Signature*

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CLAIM YOUR HEALTH AND SAFETY REIMBURSEMENT SCHOLARSHIP

Questions? Contact: