Child Care Workforce Assistance Project (CCWAP): Intent to Apply The purpose of this survey is to inform the Child Care Workforce Assistance Project team that you are intending to apply for this funding opportunity. In order to receive a formal application via email, the contact information must be correct and complete. Question Title * 1. I have applied for the NH Child Care Scholarship Program within the last 90 days and have been found ineligible due to income eligibility requirements. True False Other (please specify) Question Title * 2. I believe I am eligible for the Child Care Workforce Assistance Project and intend to apply. True False I am not sure Question Title * 3. I currently work a minimum of 25 hours per week in a licensed NH child care program that is enrolled to accept children on the NH Child Care Scholarship Program. True False I am not sure Question Title * 4. My child/children currently attend a qualified NH child care program that is enrolled to accept children on the Child Care Scholarship Program. True False Question Title * 5. Does your child have a verified diagnosed disability that rises to the level of requiring additional funding for accommodations or adaptations by the child care provider? Yes No Question Title * 6. Please provide your full name: First name Last name Question Title * 7. Please provide your email address: Email address Question Title * 8. Please provide the contact information for your employer (Program Name, Director's first and last name, and Director's email address) in the spaces below. Child Care Program Name Director's Name Director's Email Address Question Title * 9. Please list the name and email address of the Director of the child care program where your child(ren) currently attends. If this is the same person as your employer, please input the same information as in question 7.Only list information for a second program if you have multiple children and they attend different programs. Director's Name Director's Email Address Director's Name Director's Email Address Question Title * 10. The CCWAP application will be through Docusign. Please rate you familiarity with the Docusign program/process. Not at all familiar Not so familiar Somewhat familiar Very familiar Extremely familiar Not at all familiar Not so familiar Somewhat familiar Very familiar Extremely familiar Done