The following forms are for providers of child care. You may print, complete and mail or fax the appropriate forms to our office. (Forms will require Adobe Reader. Click here.)
Please be aware that the Applications are larger files and will take time to download to your computer. Thank you for your patience.
Office: 907-283-4707 FAX: 907-283-4681
Toll Free: 1-877-855-2227 Toll Free FAX: 1-877-855-2230
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.
The State of Alaska reimburses child care providers serving children of eligible, low to moderate income families participating in the Child Care Assistance Program. Only eligible providers may be paid with public funds through the program.
Child care services must be provided in the provider's residence with the exception of eligible in-home care and licensed facilities.
If you are not currently an eligible provider with our program you may complete an application. (Please see links provided below.) The cover sheet will direct the applicant to where the application must be submitted to begin the eligibility process. If you have any additional questions please contact our office.
Approved Non-Relative Provider
Approved Relative Provider
Child Care Provider Rates and Responsibilities
Child Care Provider Report of Change
In-Home Billing Form Instructions
In-Home Child Care Application
Licensed Certified Provider Application
PASS I Billing Form Instructions
PASS I Billing Form
PASS II and 111 Billing Form
PASS 11 and III Billing Form Instructions
Provider Rate Schedule
Release to Review Background Information
Substitute Caregiver Verification
Termination of Child Care Services