Section 17757 - Application for Services: ContentsThe application for services shall contain the following information:
(a) The parent's(s') full name(s), mailing address(es), telephone number(s), and email address(es), if available;(b) The names and birth dates of all children under the age of 18 years in the family, as defined in section 17700, whether or not they are served by the program;(c) The number of hours of care needed each day for each child;(d) The basis of the family's eligibility for part-day California State Preschool Program (CSPP), which may be any one of the following: (1) The parent is receiving CalWORKs cash aid;(2) The family is income eligible;(3) The family is experiencing homelessness;(4) The child is receiving child protective services;(5) The child is identified as being abused, neglected or exploited or at risk thereof;(6) The family's income is no more than 15 percent above the income eligibility threshold;(7) The child has exceptional needs; or(8) The family resides within the boundaries of the same qualified free and reduced priced meals (FRPM) school as the CSPP FRPM site.(e) The basis of the family's eligibility for full-day CSPP, which may be any one of the following: (1) The parent is receiving CalWORKs cash aid;(2) The family is income eligible;(3) The family is experiencing homelessness;(4) The child is receiving child protective services;(5) The child is identified as being abused, neglected or exploited or at risk thereof; or(6) The family resides within the boundaries of the same qualified FRPM school as the preschool program.(f) The reason(s) for needing services for full-day CSPP is (are):(1) The child is receiving child protective services;(2) The child is identified as being abused, neglected or exploited or at risk thereof;(3) The family is experiencing homelessness;(4) The parent is employed;(5) The parent is seeking employment;(6) The parent is enrolled in vocational training;(7) The parent is enrolled in educational programs;(8) The parent is incapacitated;(9) The parent is seeking permanent housing for family stability;(10) The parent does not have a need for services pursuant to Education Code section 8208(c)(1); or(11) The parent does not have a need for services pursuant to Education Code section 8217.(g) Employment, vocational training, or educational program information for the parent(s) shall include: (1) Name and phone number of the employer or contact person;(2) Name and address of the business, vocational training, or educational program; and(3) Days and hours of employment, enrollment in vocational training, or an educational program, as applicable.(h) Family size and family's adjusted monthly income, if applicable.(i) The parent's signature, signed under penalty of perjury, and date of the signature.(j) The signature of the contractor's authorized representative certifying that the family and/or child meets the criteria for receipt of services.(k) The parent's preference of receiving official communication from the contractor by mail or electronic means.Cal. Code Regs. Tit. 5, § 17757
1. New subchapter 7 (articles 1-3, sections 17757-17774) article 1 (sections 17757-17758) and section filed 7-1-2022; operative 7-1-2022 pursuant to Government Code section 11343.4(b)(3) (Register 2022, No. 26). Note: Authority cited: Sections 8207 and 8231, Education Code. Reference: Sections 8207, 8208 and 8231, Education Code.
1. New subchapter 7 (articles 1-3, sections 17757-17774) article 1 (sections 17757-17758) and section filed 7-1-2022; operative 7/1/2022 pursuant to Government Code section 11343.4(b)(3) (Register 2022, No. 26).