Financial Aid Office · 197 Franklin Street, Auburn, NY 13021

Auburn 315-255-1743 ext. 2470 · Fulton 315-592-4143 ext. 3004 · FAX 315-252-2185

Child Care Expense Documentation

Name                                                                                                   Social Security #                                

C-Number Number  C                                                            

I am requesting that my Financial Aid Cost of Attendance at Cayuga Community College be increased due to the following child care expenses:

Number of children for whom care must be provided                                                                       

Ages of children                                                                                                                                 

Average number of hours per week that care must be provided                                                       

Number of weeks that care must be provided (15 weeks per semester)                                           

                                                                        (30 weeks per year)                                                   

Total amount paid for child care for the above period $                                                                   

Name of child care provider                                                                                                               

Signature of child care provider                                                                                                         

Signature of Student                                                                                           Date                        

   Please return this form to the Financial Aid Office at Cayuga Community College