Dear Childcare Providers, 

We have funding available for reimbursement to providers who purchase equipment or curriculum materials for the children with special needs that they care for.  The required match is $1 for every $2 of grant money.  Please fill out the following application form.  



Round II, Project 2

Indiana Community Childcare Initiative Grant

Washington County

January 1, 2003-March 31, 2004

Project Coordinator:  Sheryl Jackson


Provider Name ____________________________ Provider Phone # ________________ Provider E-mail __________________

Provider Address________________________________________________________________________________________



I, ________________________ provide childcare for a child with special needs.

Provider signature_______________________________________  date______________________________________________________


Child age

Description of Special Needs

Equipment/Materials Purchased

Total Cost

Amount Reimbursable


























Explain how this equipment/materials will assist the child with special needs.