- About
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Early Childhood
Education - Family Services
- Prevention Services
Reauthorizing for CCDF? (Current Client)
Read these steps.
Reapplying for CCDF? (Not currently receiving services)
Read these steps.
Geminus CCDF email: ccdf@geminus.care
8400 Louisiana St., Merrillville, IN 46410
La Porte County: 301 East 8th St., Michigan City, IN 46360
Hace clic para los documentos
| Form | Description |
| Pre-Application Download | Form SF 56895 required to be completed prior to applying for CCDF child care. |
| Eligibility Determination Checklist Download | Letter from Geminus listing the documentation needed to sdetermine eligibility. |
| Secondary School Enrollment Verification Download | Form SF 56896 to be completed by the applicant and the applicant’s secondary education institution to show proof of enrollment. |
| Name Attestation Download | Form SF 57096 required to complete if applicant goes by more than one name. |
| Parent Applicant Worksheet Download | Form SF 56907 required to be completed by parents for their CCDF Child Care Program Application |
| Provider Information Page Download | Form SF 56907 required to be completed by parents for their CCDF Child Care Program Application |
| Residency Statement Download | Form SF 57163 to verify residence for renters. |
| Self-Employment Profit and Loss Form Download | Form SF 57101 required for applicants who are self-employed in order to provide proof of income. |
| Swipe card - Hoosier Works For Child Care Card Authorization Form Download | Swipe card form for primary and secondary card holders. |
| Tipped Employee Worksheet Download | Form SF 56904 used to compute proof of income if parent’s income is comprised of or supplemented by customer tips. |
| Wage Detail Form Download | Form SF 57100 to be completed by applicant’s employer to provide detailed proof of an applicant’s income. |
| New Hire Form Download | State Form 52951 (10-21) New Hire Verification form |
