CCTA Childcare Reimbursement Request Form

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DUE: June 28th, 2021

Name *

Email *

Are you presenting at CCTA?

Yes

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Are you an IEEE CSS Member?

Yes

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Please certify that you have read and understand the guidelines for reimbursement. (Link Here: https://ccta2021.ieeecss.org/wp-content/uploads/2021/01/CSSChildCarePolicy-Approved-Jan2020.pdf)

Yes

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Please list your anticipated request with a short justification (e.g., babysitting expenses due to time zone differences) and the request amount to aid in determining how many grants can be awarded (max $500k per family).

Is the dependent care for a child less than 12 years old?

Yes

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