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Facility/Member Name*

Facility's Member Number

Facility Address*

Facility Phone Number*

Facility Email Address*

Parent's Full Name*

Parent's Address*

Parent's ID/Driver's License #

Child's Full Name *

Child's Age (Date of Birth)*

Amount Due & Date Due*

Child #2 Full Name

Child #2 (Date of Birth)

Amount Due & Date Due

Child #3 Full name

Child #3 (Date of Birth)

Amount Due & Date Due

Child #4 Full Name

Child #4 (Date of Birth)

Amount Due & Date Due

Child #5 Full Name

Child #5 (Date of Birth)

Amount Due & Date Due*

Message

Circumstance*

*Special Notes

Privacy Disclosure: All information Reported will be held fully secure and used solely for the purpose of our partnering with Parties to come into compliance to receive Program Assistance.*

Select an option

Paycare Menu of Our 6 Main Services (*Click below):

Paycare Home|Repairs|Non-Eviction

Mission:

To prevent finances from being an obstacle between families with children/youth and the most stable housing possible.  

 

(Funds paid directly to Residential Leasing facilities on behalf of families; Home Repairs from USDA; And Non-Eviction Leases!)

Paycare 'Fresh Start' Credit Builder

Mission:

To prevent finances from being an obstacle between families with children, of even the most modest circumstances, and access to the best life outcomes possible.  

(Parents enjoy total control of their credit success story by choosing # of approvals and amount to be placed in savings!)  

Paycare Plus

Mission:

To prevent finances from being an obstacle between children/youth, from birth to Grade 12, and the best

extra-curricular/education possible.  

(Funds paid directly to Childcare & extra-curricular facilities, up to child's 12th grade!)

Paycare Scholar

Mission:

To prevent finances from being an obstacle between children/youth and the best college education possible.  

(Funds paid directly to post-secondary education facilities on behalf of families!)

Paycare Medical

Mission:

To prevent finances from being an obstacle between children/youth and the best healthcare possible.  

(Funds paid directly to medical, clinical,  and health facilities on behalf of families!)

Paycare Auto

Mission:

To prevent finances from being an obstacle between families with children/youth and dependable transportation.  

(Funds paid directly to auto repair and sales dealerships on behalf of families!)

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