Family Reduced Fee Application
The Day Care Program provides reduced fees to eligible families with a gross household income below $80,000. To receive a reduction in fees you must and submit the Reduced Fee Eligibility Form. This form must be completed for the summer and school year programs, include all necessary verification and be on file with the Extended Day Care Office to be considered for reduced fee eligibility. All applicants will also be required to complete a Consent To Exchange Information Form to further verify income information. These forms must be printed and submitted. They cannot be submitted online. Fee reductions will take place at the next payment period after verification. Re-certification is done annually regardless of the start date, and changes occur throughout the year.

The Day Care Program works with the City of Falls Church Housing and Human Services Division to meet the financial needs of our families. Please contact the Housing and Human Services Division at 703-248-5005 for information about other services available to Falls Church City residents.

Income includes:

Salary

Other Income – Child support, alimony, disability, income from other household members, veteran’s benefits, TANF/VIEW assistance, unemployment benefits, social security benefits.

Military Personnel – in addition to basic pay, special allowances such as BAH, BAS, and CMA are considered earned income.

Self-employed, no pay stubs: If you are self- employed or do not receive pay stubs from your employer, the following documentation is required:

Self-Employed – a copy of the most recent tax return, if self-employed less than 12 months –complete Self-Employed Information Form...
No pay stubs – letter from employer stating hourly, monthly or annual salary

No-Income Status:
• Undergraduate School or Job Training – documentation verifying enrollment and payment of tuition must
be returned with the Reduced Fee Eligibility Form.

• Disabled – verification of a disability from medical professionals
Email *
Today's date: *
MM
/
DD
/
YYYY
Names of children enrolled in EDCP: *
Names and relationships of ALL household members *
GROSS monthly income: *
Sources of income: choose all that apply *
Required
If you checked any of the above boxes BESIDES "salary" please indicate how much you receive monthly: *
Verification of all income is required when applying for Reduced Fees. You may email your two most recent pay stubs to clintonk@fccps.org. Thank you.
Clear selection
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Falls Church City Public Schools. Report Abuse