Pre-application: Temporary Childcare Assistance Scholarship Program

[{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"header","subtype":"h2","label":"Tell us about yourself:","className":"d-block"},{"type":"checkbox-group","required":true,"label":"Are you a Public Housing resident of Columbia Housing?","description":"Resident of CH?","name":"CH-resident-status","className":"d-block","values":[{"label":"Yes, I currently live in a Public Housing owned by Columbia Housing","value":"Yes","selected":true},{"label":"No. You must be a Public Housing Resident of Columbia Housing to qualify.","value":"No"}]},{"type":"text","required":true,"label":"Last Name","description":"Last Name","name":"Last-Name","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"First Name","description":"First Name","name":"First-Name","className":"d-block","subtype":"text"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"d-block"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"d-block"},{"type":"text","required":true,"label":"Address","description":"Address","name":"Address","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"City","description":"City","name":"City","className":"d-block","subtype":"text"},{"type":"text","required":true,"label":"Zip code","description":"Zip code","name":"Zip-code","className":"d-block","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Phone Number","description":"Phone Number","name":"Phone-Number","className":"d-block"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"checkbox-group","required":true,"label":"Are you attending school?","description":"Are you in school?","name":"School-status","className":"d-block","values":[{"label":"Yes, I am a student.","value":"Yes"},{"label":"No, I do not attend school.","value":"No"}]},{"type":"text","label":"Where do you attend school?","description":"Where do you attend school?","name":"HoH-School-name","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"<hr>","className":"d-block"},{"type":"checkbox-group","required":true,"label":"Are you currently employed?","description":"Are you working?","name":"Employment-status","className":"d-block","values":[{"label":"Yes, I am currently working.","value":"Yes"},{"label":"No, I am not employed.","value":"No"}]},{"type":"text","label":"Where are you currently working?","description":"Where do you work?","name":"place-of-employment","className":"d-block","subtype":"text"},{"type":"date","label":"When did you begin working at your current job?","description":"Job start date","name":"Job-start-date","className":"d-block"},{"type":"checkbox-group","required":true,"label":"Are you currently in a work training program or do you have a job confirmed that will start soon?","description":"Job training or prospects?","name":"job-training-program-or-prospects","className":"d-block","values":[{"label":"Yes, I am currently in a work training program.","value":"Yes work training"},{"label":"Yes, I have a job lined up that will start soon.","value":"Yes job starting soon"},{"label":"No, these do not apply to me.","value":"No"}]},{"type":"text","label":"Where are you currently being trained or will be working?","description":"Where are you being trained or going back to work?","name":"Place-of-Employment-or-training","className":"d-block","subtype":"text"},{"type":"paragraph","subtype":"p","label":"If you started a job within the last 30 days or or preparing to return to work within the next 2 weeks, you must obtain a letter on the employer's letterhead indicating your hourly wage, start date, weekly hours, and pay schedule.  You will also need to submit your most recent pay stubs. ","className":"d-block"},{"type":"header","subtype":"h2","label":"Tell us about your children:","className":"d-block"},{"type":"number","required":true,"label":"How many children do you have?","description":"Number of children","name":"Number-of-Children","className":"d-block"},{"type":"paragraph","subtype":"p","label":"If you are currently pregnant, you must wait to apply once your child is at least 6-8 weeks old and able to placed in a childcare facility.","className":"d-block"},{"type":"number","required":true,"label":"How many of your children need childcare?","description":"Childcare needs","name":"Childcare-needs","className":"d-block"},{"type":"textarea","required":true,"label":"Please list your children's names and ages","description":"Childrens names and ages","name":"Childrens-names-and-ages","subtype":"textarea","rows":6,"className":"d-block"},{"type":"header","subtype":"h2","label":"Tell us about your current childcare:","className":"d-block"},{"type":"text","required":true,"label":"Who is currently watching your children while you attend school or work?","description":"Current childcare provider","name":"Current-childcare-provider","className":"d-block","subtype":"text"},{"type":"checkbox-group","required":true,"label":"Have you applied for childcare assistance previously through another publicly funded program?","description":"Have you applied for childcare assistance before?","name":"Applied-for-childcare-assistance-before","className":"d-block","values":[{"label":"Yes, I have.","value":"Yes"},{"label":"No, I have not.","value":"No"}]},{"type":"paragraph","subtype":"p","label":"Thank you for expressing interest in the Temporary Childcare Assistance Program.  A representative from the Resident Family Services department will contact you soon regarding next steps.","className":"d-block"}]

Pre-application: Temporary Childcare Assistance Scholarship Program

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