Transcription of CHILD CARE APPLICATION
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CHILD CARE APPLICATION
South Carolina Department of Social ServicesSC Voucher ProgramCHILD care APPLICATIONSi necesita esta aplicaci n en idioma espa ol, llame al 1-800-476-0199 por COMPLETE IN BLUE OR BLACK INKAND COMPLETE ALLSECTIONSDSS Form 3791 (MAY 19) Edition of a APR 16 is nnNnnSingle Parent FamilynnTwo Parent FamilynnSingle Parent Guardian/In LocoParentisnnTwo Parent Guardian/In LocoParentisnnFoster CHILD of a Single ParentFamilynnFoster CHILD of a Two Parent FamilynnFoster CHILD with a ChildnnSinglennMarriednnSeparatednnDivor cednnWidowednnNot Applicable Child1. Tell us who you are and where you AGENCY USE ONLYP rogram Name/Eligibility Category:CCVS APPLICATION No.:Last Name:First Name:Residence Address:Social Security Number:Birthdate:County: (You live in)E-Mail:City:Mid.
5. Tell us about the children who need child care services. Child’s First Name: Child’s Last Name: American Indian or Alaskan Native Is the child a
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