The LeeShore Center

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

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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.

PLEASE NOTE: Provider forms uploaded 8/20/15

Thank you

Approved Non-Relative Provider

Approved Relative Provider

Child Care Provider Rates and Responsibilities

Child Care Provider Report of Change

In-Home Billing

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