Transcription of Great START Supplement Application
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Great START Supplement Application
Great START Supplement Application For questions and additional information about the Great START Wage Supplement Program please call or visit us at Name: _____. SSN: ____ ____ ____ - ____ ____ - ____ ____ ____ ____. What Great START Level and Option are you applying for? Level_ _____ , Option_ _____ (see Great START Wage Supplement Scale ). Have you taken any leave of absence of more than 6 weeks in the last year? m No m Yes, from __/__/__ to __/__/__. Hourly Pay / Salary: $_____ per hour / per year (circle one). Hours worked per week: _____ Weeks worked per year: _____. How did you first learn about Great START ? (check only one). m Center Director m Local Child Care Resource & Referral m Conference/Presentation m Mailing m Co-Worker m Provider Association m Website m Other _____. Additional Program Information (to be completed by program director). Director/Owner Name: _ _____. Current Enrollment:_ _____ # IDHS CCAP children currently in care:_ _____.
Great START Supplement Application Checklist & Required Documentation Please use the checklist provided to ensure that you have submitted all of the necessary documents needed to
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