H & S Scholarship Form 25-26

Health and Safety Scholarship Application

Funded by a grant from the California Department of Social Services
The Resource Connection Resource and Referral Services is offering Health & Safety Training funds to reimburse Licensed Center-based Staff, Licensed Family Child Care Providers, License-Exempt/TrustLine Child Care Providers and In-home Child Care providers that have completed the health and safety training requirements as outlined in AB243.

Each eligible provider may receive up to $150 towards payment for completed classes or course work per year. Reimbursement will not exceed the actual costs incurred. Reimbursements will be provided on a first come, first serve basis. Priorities for payments:
1. Small Family Child Care Licensees (1 per facility)
2. Large Family Child Care Licensee and Assistant (2 per facility)
3. Private Child Care Center Director & Lead Teacher (2 per facility)
4. TrustLine and Exempt Providers (provider only)
Once all priorities are processed, any remaining funds will be distributed to additional applicants.

To qualify for this reimbursement, providers will need to:
- Provide care in Amador or Calaveras Counties
- Be a newly licensed provider, a licensed provider, exempt or TrustLine provider, child care center director or staff who needs to obtain or renew their CPR or First Aid certificate(s)
- Complete the Health and Safety training between July 1, 2025 and June 15, 2026
- All applications for reimbursement must be in the Resource and Referral office by June 15th, 2026.
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Health and Safety Scholarship Application 2025-2025 is funded by a grant from the California Department of Social Services.

The Resource Connection cannot process incomplete applications or applications that are submitted without copies of cards/certificates and receipts. We will reimburse for courses that are Child Care Provider EMSA approved. Not all CPR or First Aid courses will meet the requirements for licensed child care facilities. Go to the EMS Authority website at https://emsa.ca.gov/childcare provider1/ to confirm the approval of a training program.

Scholarship is available until funding is exhausted.
Participant Name*
Participant Information
Phone Number*
Mailing Address*
Position (please check one)*

Licensed Center Base StaffLicense-exempt Child Care ProviderLicensed Family Child Care ProviderIn-home Child Care Provider
Name of Employer/Facility*
Facility Address*
Employer/ Facility Information
Facility Mailing Address (if employer to be reimbursed)
Person To Be Reimbursed (Please check one) The person to be reimbursed is the person that paid for the course.*

ParticipantEmployer
Name of Health and Safety Trainer*
Training Institution as listed on the certificate
Name of course
Training Information
Number of hours*
Fee Paid*
IMPORTANT! YOU MUST UPLOAD THE FOLLOWING WITH YOUR APPLICATION:
- COPIES OF FRONT AND BACK OF YOUR SIGNED & DATED TRAINING CARDS OR CERTIFICATES,
- RECEIPT OF PAYMENT TO TRAINING INSTITUTION
- W-9 (ONLY IF YOU HAVE NOT RECEIVED A PAYMENT FROM TRC BEFORE)
File Upload*

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Health and Safety Scholarship Application

Participant Information

Employer/ Facility Information

Training Information