Coast Guard Foundation-Family Childcare Center Grant Application

Coast Guard Foundation Family Child Care (FCC) Provider Grant Application

OPEN APPLICATION PERIOD
Date*

MonthDayYear
Date
Read and follow the instructions carefully prior to submitting your application. Submission of an application does not guarantee a grant award. All applications will be verified for eligibility with the United States Coast Guard's Office of Work-Life.
Read and Understand the instructions.*

Yes, I have
To complete the verficiation process, review applications and generate correspondence and award agreements, we will use the personal information submitted below. Please double check spelling, capitalization and punctuation.
I. Personal Data:

Tell us about yourself
Full Name*

First NameLast Name
Birthdate:*

MonthDayYear
Mobile No. :*

Area CodePhone Number
E-mail :*
Where the confirmation will be send to
Home Address :

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Gender:

MaleFemale
Please indicate your status as an FCC provider*

Yes. I have made first-step contact with the local Child Development Services Specialist and registered my interest to become a certified childcare provider.Yes. I am at the in-progress provider status and working towards provisional certification with a plan to become an approved FCC provider.Yes. I have received provisional approval to be a certified FCC provider with a plan to become an approved FCC provider.Yes. I have been approved to be an FCC provider.I am not sure of the status of my FCC provider application. Please contact me to discuss.
Are you a Coast Guard spouse residing in Coast Guard-owned housing or transferring and plan to live in Coast Guard-owned housing?

YesNoOther
If yes, please share with us the tenant command, city and state of your Coast Guard-owned housing.*
Base Kodiak, Kodiak, Alaska (for example)
How will the Coast Guard Foundation grant help you establish became a family child care provider? *

0/300
What impact will this grant have for your family and the Coast Guard community?*

0/300
I. Coast Guard Sponsor Data:

Tell us about your Coast Guard sponsor
Employee ID*
(please do not provide your social security number)
Coast Guard Rank*
Rank
Sponsor Name*

First NameLast Name
Sponsor Email Address*
example@example.com
Phone Number*

Area CodePhone Number
Coast Guard Unit (include city and state)*
unit name and location
VIII. Applicant's E-Signature
I agree, if the applicant is selected as a grant recipient, applicant, and sponsor name, along with sponsor duty location will be used for purposes of news and publicity of the Coast Guard Foundation FCC Provider Grant Program by Commandant (CG-1112) and the Coast Guard Foundation for current and future promotions of the FCC Provider Grant program.

By signing (typing your legal name) in the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
E-Signature:*
Date

MonthDayYear
Date
Coast Guard Foundation is committed to equal opportunity in employment and education. CGF does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, or any other protected class.
Should be Empty:

Coast Guard Foundation Family Child Care (FCC) Provider Grant Application

I. Personal Data:

I. Coast Guard Sponsor Data:

VIII. Applicant's E-Signature