REWARD$ Application Form
You will need your current Registry Participant Education and Professional Development Report (PD Report) to complete some of the application information. This will give you an opportunity to make sure your Registry account information is complete and up to date.
Registry ID Number *
Fall 2017 REWARD$ Application Form
Your answer
First Name *
Your legal first name (as it appears on your social security card)
Your answer
Last Name *
Your legal last name (as it appears on your social security card)
Your answer
Email Address *
Email address that is associated with your Registry account (the email address you use to log into your Registry account). This is the email you must use when submitting the required documents to complete your application. This is the email address the REWARD$ Team will use to communicate with you.
Your answer
Mailing Address (Street Address or PO Box) *
REWARD$ will mail incentive check to this address.
Your answer
Mailing Address (City) *
REWARD$ will mail incentive check to this address
Your answer
Mailing Address (Zip Code) *
REWARD$ will mail incentive check to this address
Your answer
Telephone Number *
A reliable daytime contact phone number. Example (xxx) yyy-zzzz
Your answer
Date of Birth *
Applicants must be at least 18 years of age and be lawfully present in the U.S.
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FTF Regional Partnership Counxil (RPC) *
In which FTF Regional Council area do you work? You must be working in one of these regions to be eligible for a REWARD$ incentive.
Employer Registry ID Number *
From your PD Report
Your answer
Employer Name *
Legal name as it appears on the child care license - name of the program where you physically work, NOT the name of the administrative office/school district
Your answer
Employer Street Address *
The physical address of the location where you work.
Your answer
Employer City *
The city of the location where you work.
Your answer
Employer Zip Code *
The zip code of the location where you work.
Your answer
Employer Telephone Number *
Your answer
Position Title *
If your position title does not match one of the choices, you will need to contact the REWARD$ office
What is your hourly wage? *
Example: $11.58
Your answer
How many hours per week do you work? *
How many weeks per year do you work? *
When did you begin working for your current employer? *
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Registry Career Lattice Level *
From your PD Report. Your REWARD$ incentive is based on your Lattice level
I have received a FTF Scholarship Bonus
If you have received a Bonus provide the date the last Bonus was received.
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I have received a REWARD$ incentive
If you have received an Incentive provide the date the last Incentive was received.
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YYYY
You are almost done!
You MUST now submit a W-9 and Statement of Lawful Presence form, forms are available on the REWARD$ webpage. Submit documents from the SAME email you use for your Registry account! Each applicant must submit their own documents.
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