General Information

Bold indicates a required field

Parent Information
Guardian First Name  
Guardian Last Name
  

Single Parent 


 

Mailing Address

  

City

  

State

  

Zip

  

County

  

Home Phone Number

  

Work Phone Number

Cell Phone Number

E-Mail Address

Must be provided if you would like information emailed to you.

Fax Number

Employer of Parent/Guardian

  

Employer of Spouse

Child Information

Child Name/Expecting 

 

Birth Date(s)/Due Date 
(mm/dd/yyyy)

  
   

Your Information (if different than parent)

Your First & Last Name

Your Mailing Address

Your City

  
Your State
Your Zip



Search Criteria

Cross Streets/Location
Location   
Type of Day Care   

Start Date of Child Care   
<January 2009>
SunMonTueWedThuFriSat
28293031123
45678910
11121314151617
18192021222324
25262728293031
1234567
Day Care is Needed   


Time Care is Needed    From

To

 
Type of Schedule
Year Schedule
Special Schedule

Special Program

School Location/Name of Elementary School
Special Needs (please specify)


Subsidy

Is the Michigan Department of Human Services helping to pay for care?


DHS (formerly FIA) offers a program to assist low to moderate income families pay for child care. Eligibility is based on family size and income. To qualify, the gross income must be below the amounts listed below.
(Source)

Family Size Bi-weekly Income
2 $742
3 $918
4 $1092
5 $1267
6 $1441
7 $1615
Based on the income information above, do you think you might qualify for assistance paying for care?
Would you like to receive information about MI Child Health Insurance?
How were you referred to us? 



Reason For Care

What is your reason for needing child care?


How would you like us to send your information?  
Additional Comments