Application for Reimbursement of National Association Family Child Care (NAFCC) fees Eligible Staffed Family Child Care (SFCCN) Provider members may use this form to request reimbursement of fees paid to NAFCC since July 1, 2023.You must meet the following eligibility criteria: At the time of submitting this application, you are a Staffed Family Child Care Provider Member in one of the following networks: Region 1 TEAM, Inc. Region 2 City of Hartford, Region 3 CTAEYC, Region 4 CTAEYC, Region 5 CTAEYC. You incurred the fees between July 1, 2023 and November 30, 2023. You are able to provide proof of payment made to NAFCC. You are requesting reimbursement of fees for one of the following: ($45.00 )NAFCC membership, $310.00 Self-Study Enrollment Kit, ($525.00) Accreditation Application, ($160.00)18-Month Update, $525.00 Re- Accreditation.What SFCCN are you an active member of? TEAM, Inc – Region 1 City of Hartford – Region 2 CTAEYC – Region 3 CTAEYC – Region 4 CTAEYC – Region 5 CTAEYC – Region 6 Name(Required) Please enter your legal name. Your legal name is the name you use to pay your taxes and will allow you to cash the check in this name. License Number(Required) This is a 5 digit number with DCFH. credential.What fees are you requesting reimbursement from?(Required) ($45.00 )NAFCC Membership ($310.00) Self-Study Enrollment Kit ($525.00) Accreditation Application ($160.00)18-Month Update ($525.00) Re- Accreditation What was the payment date?(Required) Enter the date you made this payment to NAFCCProvide documentation of the payment you made(Required)Max. file size: 50 MB.You must submit documentation that proves you made payment to NAFCC. This could be an image of the cashed check, a bank statement or credit card statement.W9 Needed – Please Upload(Required)Max. file size: 50 MB.In order for the United Way of Connecticut to reimburse you, a W9 needs to be submitted. Please ensure it is signed and dated.Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country
