Temporary Assistance for Needy Families Preschool Enrollment Application 2024-2025

Preschool Information*

Name of Preschool

Site name/location*

Site name/location

Name of contact person from preschool or site director*

Legal guardian *

First nameLast name

Child name*

First nameLast name

Child information*

Social security numberDate of birth

Primary language spoken in the home*

Child Race/Ethnicity*

Address*

Street address

Street address line 2

CityState / Province

Postal / Zip Code

Phone number*

Please enter a valid phone number.

How were you referred to TANF? I.e. Search engine, case worker, friend/relative, other.

Is your family's current living situation due to a loss of housing or financial hardship?*

YesNoOther

Are there any siblings five years old or younger living in the household?*

YesNoOther

Are you or the children in your care currently lacking a fixed, regular, and adequate nighttime residence? Which includes one of the following: • Place not meant for human habitation. • Living in a shelter (Emergency shelter, hotel/motel paid by government or charitable organization)*

YesNoOther

Homeless notes as needed

Is your family on a plan of safe care?

How often are you paid?*

Income verification type i.e. pay stub, W-2, self report...*

Type of verification used

How many adults are living in your home?*

How many children are living in your home?*

What is the total gross monthly income for all adults in your household?*

Including any public benefits

Signature*

Upload file including parent/guardian signature.

Do you have paystubs to include?*

YesNo

Is this child covered under Kidcare chip?*

YesNoNot sure

Would you like to enroll to receive child health insurance services?*

YesNoNot sure

Would you like additional information about assistance in the community? food pantry, rental assistance, shelter etc....*

YesNoOther

Eligibility Guidelines for TANF Money (Non-Assistance)

● TANF money shall only be used for one (1) or more of the following:

1. Provide assistance to needy families so that children may be cared for in their own homes or in the homes of relatives;

2. End the dependence of needy parents on government benefits by promoting job preparation, work and marriage;

3. Prevent and reduce out-of-wedlock pregnancies; and establish annual numerical goals for preventing and reducing the incidence of these pregnancies; and

4. Encourage the formation and maintenance of two parent families.

● Contractor shall be specific on what TANF purpose their program/service is addressing.

● Participants served shall be families with a child(ren) with income below 185% of the Federal Poverty Level (FPL).

● Participants also shall meet citizenship/eligible immigrant and residency criteria to be served.

● Programs will be operated on a cost reimbursement basis.

● Administrative costs are limited to 10% of the program cost. Program costs are costs associated with the delivery of the service.

● Performance measures are required. The Contractor shall address how performance measures and data collection will occur to validate the program success.

● Reporting is also required when utilizing TANF funds. The following reports shall be required:

● Monthly/quarterly program performance reports will address program outcomes, successes, challenges and client tracking;

● Monthly/quarterly fiscal reports;

● List of clients served each month; and

● Final summary report.

● TANF funds shall not be used to provide individuals served by the projects with cash, cash cards or check(s) payable directly to the individual(s) or credit card company gift cards.

Upload income documents

Temporary Assistance for Needy Families Preschool Enrollment Application 2024-2025

Form will be submitted to Amy Reyes, TANF grant administrator. Wyoming Department of Education. TANF money shall only be used for one (1) or more of the following: