14341 Yale Ave.
Irvine, CA 92604
This application is for funding between July 1, 2022 and June 30, 2023.
Prior to submitting your application, contact the ICCP Program at your child’s elementary school campus to inquire about enrollment availability and rates.
Scholarship funding is provided by the Irvine Children's Fund (ICF). ICF is a local nonprofit community support organization whose mission is to raise funds to increase access to quality child care for income eligible working families in Irvine.
No fax or email applications will be accepted. For questions, please call 949-724-6632.
Reminder: Applications received more than 30 days prior to planned start date will be disqualified. A new application will need to be submitted no more than 30 days prior to start date.
Desired start date at the child care program selected above:
I have contacted the ICCP child care program selected above in inquire about enrollment availability and rates
Reminder: You must contact the selected ICCP child care program directly to inquire about enrollment availability and rates.
Please note: Families must enroll in the designated ICCP child care program within 30 days of the scholarship offer; otherwise funds will be released for other families and the recipient must reapply for funding, so it is important to ensure the program has a space available for your child prior to applying for the scholarship.
Choose your start date for the program selected above:
Have you received an ICCP Scholarship in the past?
If yes, indicate date awarded:
How did you hear about the ICCP Scholarship Program?:
FOR Families provides free information and short-term support to individuals, couples, and families living in Irvine who need assistance identifying and accessing needed services and resources. FOR Families services include consultations to help identify your needs, resource referrals to organization and programs best suited to assist you, and customized action plans to help individuals as they move forward. To learn more, obtain contact information to make an appointment, or to access a variety of online resources, please click here.
In addition, the City provides information and resources about the following topics online:
Resources for Parenting During COVID-19
Health Insurance Enrollment Assistance
Child Care and Development Information
Training Calendar for Parent and Caregiver Events
This program is funded by a federal grant and we are required to collect certain information for reporting purposes. This information is confidential and will be used to compile statistical data only.
Please complete the following information:
Household Composition and Income
Enter required information for all household members, including all children. Income documentation or declaration of no-income is required for all family members in the household 18 years and older. For family members under the age of 18 that do not work, select "student" and an annual income of "$0."
Head of Household Gender:
Is the Head of Household Disabled?
Are you now, or have you ever, served in the United States Military:
Are you (check all that apply):
If currently unemployed, what was the last date of employment:
Is Household Member 2 Disabled?
Have they now, or have they ever, served in the United States Military:
Do you have a third household member?
Is Household Member 3 Disabled?
Do you have a fourth family member?
Is Household Member 4 Disabled?
Do you have a fifth household member?
Is Household Member 5 Disabled?
Do you have a sixth household member?
Is Household Member 6 Disabled?
Do you have a seventh household member?
Is Household Member 7 Disabled?
Do you have a eighth household member?
Is Household Member 8 Disabled?
Do you have a ninth household member?
Is Household Member 9 Disabled?
Do you have a tenth household member?
Is Household Member 10 Disabled?
Household Gross Monthly Income
List the Household Gross Monthly Income (in dollars) next to each Source of Income Do not leave any box blank. If you do not have income from that source, enter "0" in the box provided.
Source of Income: Salary
Source of Income: SSI/SSD (Supplemental Security Income/Disability)
Source of Income: Aid for Families with Dependent Children's (AFDC)
Source of Income: General Relief
Source of Income: Pension
Source of Income: Alimony
Source of Income: Child Support
Source of Income: Unemployment Insurance
Source of Income: Self-Employment Profits
Source of Income: Interest from Bank Accounts and Cash Funds
Source of Income: Rental Property Income
Source of Income: Other Income (not shown above)
Duplications of Benefits Certification
I certify that I have not received nor will accept other federal, state, local, or private assistance that duplicates the assistance provided under this Program.
I certify that if I receive duplicative assistance, I will notify the Irvine Child Care Project within seven (7) days.
Upload Your Documents
The following documents are used to verify income in relation to scholarship eligibility. Please upload any and/or all of the following for further scholarship evaluation. After submission, you may be asked for additional documentation to verify eligibility.
A copy of your entire federal tax return for the most recent tax year (must include a signature). Only those children listed as dependents on the tax return are eligible for scholarship funds.
A copy of the W-2 form for each working adult listed on the tax return. If self-employed, please provide 1099 or Schedule C.
Proof of Irvine residency (copy of driver's license or utility bill). Please see Irvine Unified School District's list of acceptable proof of residency documents for alternative options.
Copies of the three most recent employment check stubs, fewer than 30 days old and for each working adult listed on the tax return; copies of the four most recent employment stubs, fewer than 60 days old for each working adult listed on the tax return if paid weekly.
A copy of proof of any other income/support received. Please provide most recent award letter indicating monthly disbursement for any of the following: child support, alimony, cash assistance, Social Security, disability, food assistance, child care assistance, etc. Medi-Cal is not applicable.
Note: Further information may be required to complete your application. Without the above information, your application may be denied.
According to Title 18, Section 1001 of the U.S. Code, it is a felony for any person to knowingly and willingly make false or fraudulent statements to any department of the United States Government. I, the undersigned hereby certify that all statements contained herein, are true and correct to the best of my knowledge and belief. I understand the information I provide in this certification is subject to verification, and I agree to provide necessary documentation if requested to do so.
Under the penalty of perjury, I certify that the above information is true and correct.
Digital Signature: Please enter your name, email address and sign the document.
The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, the personal information noted by an asterisk (*) on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, business, or individuals.