The LeeShore Center

907-283-9479 (Office)           907-283-7257 (Crisis Line)          907-283-5844 (Fax)

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 Child Care Assistance Program Family Information

                                            Office: 907-283-4707
                                         Toll Free: 877-855-2227

For your convenience this page will contain links to all of the files you will need to access for Child Care Assistance. (Forms may require Adobe Reader. Download here.)

You may click on the following links, print the files and complete. You may submit any of the forms found on this web page in person, by mail or fax. Please be aware that the Applications are larger files and will take time to download to your computer. Thank you for your patience.

PLEASE NOTE: new forms uploaded 8/20/15

Thank you

Application for Alaska Inclusive Child Care

Child Care Assistance Application

Child Support Services Verification Form

Employment Statement

Family Contribution Schedule

Family Report of Change

Health Status Report

Monthly Tip Ledger

Self Employment Income Deduction Worksheet

Statement of Support Provided CSSD

Statement of Support Received CSSD

Termination of Child Care Services

Understanding your Authorization

Understanding your Co-Pay


Office: 907-283-4707                                                          FAX: 907-283-4681

Toll Free: 1-877-855-2227                                                  Toll Free FAX: 1-877-855-2230

Eligibility Guidelines:    

  • Working - or - Attending school/training - or - Looking for Work
  • Income Eligibility - the amount of assistance is based on family size and gross monthly income on a sliding fee basis (see "Family Contribution Schedule" below for family size and income detail). Gross monthly income is determined using both earned and unearned income being received by the family.
  • Age Eligibility - children up to 13 years of age or children 13 to 19 years of age who have a developmental disability
  • Eligible Provider - select a child care provider who is eligible to participate in the Child Care Assistance Program

Alaska's Statewide Child Care Resource and Referral Network, thread, offers referral services to parents needing assistance with locating child care providers.

If you meet the guidelines listed above, you may be eligible to receive assistance with your child care costs. Print the "Family Application" found below. Print, complete, attach required documentation and submit to our office. If you have any further questions regarding eligibility, please contact our office. You may visit the State of Alaska website for an online child care calculator, forms and resources.

Required Documentation:

  •     A completed Child Care Assistance Application
  •     A copy of your government issued photo identification card
  •     Proof of your family's gross monthly income
  •     Proof of age for the children who will be receiving assistance. 

Office Hours: Monday - Friday  8:00 a.m. - 5 p.m.

We are located on the second floor of the Seaman Building: 601 Frontage Road, Suite 204, Kenai.