DNSSAB | Service Provider Appeal Form

DNSSAB Children's Services

Service Provider Appeal Form

This information is collected under the legal authority of the Child Care and Early Years Act, 2014 for administering the programs and services prescribed or authorized under this Act.

Yes, I give permission to store and process my data

Contact Information

First Name

Daytime Phone Number

Licensed Child Care Agency

My licensed child care agency currently has a Service Agreement with DNSSAB.

Yes

Last Name

Child Care Site

Reason for Appeal

WEG/HCCEG

CWELCC

Special Purpose Funding

Workforce Funding

Other

Details of Appeal

Please outline the details of your appeal, providing as much information as possible.

Please upload any supporting documentation for your appeal here.

Please confirm that you are not a robot.