Child Care Voucher

Returning CCDF applicants and recipients

Reauthorizing for CCDF? (Current Client)

Read these steps.

  1. Download and fill out the Parent Application Worksheet and have the Provider Information Page completed by the CCDF provider of your choice.
  2. Make a copy of supporting documentation (e.g., check stubs, ID).
  3. Email or mail your forms and supporting documentation no later than 1 week prior to your subsidy end date.

Reapplying for CCDF? (Not currently receiving services)

Read these steps.

  1. Download and fill out the Pre-Application form.
  2. Email or mail your forms and supporting documentation.

Geminus CCDF email: ccdf@geminus.care

8400 Louisiana St., Merrillville, IN 46410

La Porte County: 301 East 8th St., Michigan City, IN 46360


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.

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