Application for Childcare Subsidy

Parents may fill out this form once per academic year and are encouraged to do so by October 1. Students who are on leave or become new parents may apply by December 15, March 1, or June 1. Please note that GSAS does not process Childcare Subsidy applications on a rolling basis. Applications are processed four times per academic year in correlation with the above deadlines.

PERSONAL INFORMATION

LAST NAME:

FIRST NAME:

UNI:

DEPARTMENT OR PROGRAM:

YEAR OF FIRST REGISTRATION AT GSAS:

Parents who are doctoral students in years 1 through 7 of an Arts and Sciences program may be eligible to receive one $5,500 subsidy per academic year for each child who is 1) under the age of six and 2) not yet attending kindergarten. If both parents are GSAS students, they both may apply individually for the childcare subsidy.

INFORMATION ON ELIGIBLE CHILDREN

For each eligible child, please attach a copy of his/her birth certificate or adoption documents (if not previously submitted to GSAS). The birth certificate should be saved as the student's last name, followed by a period and the year of the child's birth (i.e. LASTNAME.2023). Students may also bring a copy of the birth certificate to the Office of Student Affairs (Low Library, Room 107).

If you have received the childcare subsidy in a previous academic year, you are not required to resubmit your child's birth certificate or adoption documents.

FIRST ELIGIBLE CHILD’S NAME:

DATE OF BIRTH:

AGE:

FIRST CHILD'S BIRTH CERTIFICATE:

Is this child attending kindergarten?

YesNo

SECOND ELIGIBLE CHILD’S NAME:

DATE OF BIRTH:

AGE:

SECOND CHILD'S BIRTH CERTIFICATE:

Is this child attending kindergarten?

YesNo

THIRD ELIGIBLE CHILD’S NAME:

DATE OF BIRTH:

AGE:

THIRD CHILD'S BIRTH CERTIFICATE:

Is this child attending kindergarten?

YesNo

ADDITIONAL INFORMATION OR COMMENTS

SIGNATURE OF PARENT

DATE

Contact Information