COVID-19 Childcare Stabilization - Self Certification URLThis field is for validation purposes and should be left unchanged. The Stabilization program will cover the amount of tuition that parents are unable or unwilling to pay. The COVID-19 Child Care Stabilization Payment Program for Private Tuition is intended to support child care programs regardless of closure, being open or schedule status, to maintain tuition payments to hold spaces for the children enrolled prior to the COVID-19 crisis. If a family cannot afford to pay or is unwilling to pay their child care program during this time, due to current or future financial difficulty during COVID-19 crisis the State of Vermont has approved this program to support child care programs and families financially whose enrolled families are unable to pay or unwilling to pay tuition or co-payments during this Closure Period. You may resubmit this form at any time if your situation changes during this closure.School*Ethan AllenTechnology ParkEmail address* Parent/Guardian Last Name*Name of Child 1*Name of Child 2Name of Child 3Are you able to continue to pay the tuition for your child(ren) when it next becomes due?* Yes No Partially Self Certification for non-payment of tuitionPlease choose from one of the following reasons for not being able to continue to pay your childcare tuition when it next falls due.* Parent reports reduced employment hours Parent reports unemployment Parent reports unwilling to pay Parents reports unable to pay Parents reports paying a different childcare provider Please certify your reason set out above* I acknowledge that the information above is accurate and true I understand that [Program] retains the right to recoup funds as a result of inaccurate or incorrect information provided I understand that I will inform [Program] of any change in circumstance that impacts my ability to pay tuition Partial Payment of TuitionPlease indicate the amount of tuition that you feel able to currently pay (per week)*Consent* I authorize Kid Logic Learning to submit this information on my/our behalf to the Vermont Dept for Children and Families Child Development division pertaining to the COVID-19 Child Care Stabilization Payments for Private Tuitions.Signature*
