Get a jump start on your child care benefit eligibility by referring your current child care provider! We will do outreach on your behalf to check their eligibility and begin onboarding them as an Active CCW Provider to accept your benefit, if approved.

1.Employer Name

2.Employee Information

Your name

Email address

3.Child Care Provider Information

Provider Name

Provider Address

Provider Phone Number

Provider Email Address

4.Eligible child care providers must be either Licensed and/or Subsidy-Registered. Please report your provider's eligibility status, if known:

Licensed

Subsidy-registered

None of the above

I'm not sure

5.Have you communicated with your provider about Child Care Works benefits?

Yes

No

Other (please specify)