INSTRUCTIONS: ARIZONA CERTIFIED FAMILY CHILD CARE PROVIDER APPLICATION (ADDENDUM) (Form CC-200-A-FF)

When applying for a position as an Arizona certified family child care provider, an application must be submitted using a form CC-200-FF. If there is not sufficient space on this form to document all household members or adult and minor children who live out of your home, use a supplemental form CC-200-A-FF to document them. This form can be obtained from the website maintained by the Arizona Department of Economic Security.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 1: At the top of the page, enter your last name, first name and middle initial.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 2: The first table provided is for documentation of household members including your spouse. In the first column, enter the last name, first name and middle name of all household members.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 3: In the second column, enter the birth date of all household members.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 4: In the third column, enter the Social Security number of all household members.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 5: In the fourth column, write the relationship of this household member to you.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 6: In the fifth column, indicate with a check mark whether or not each household member is 18 years or older.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 7: The next table provided is for documentation of adult and minor children who do not live in your home. Include your spouse's children and step-children. In the first column, enter the last name, first name and middle name of all such adult and minor children.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 8: In the second column, give the birthdate of all minor and adult children.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 9: In the third column, give the Social Security number of all minor and adult children.

Arizona Certified Family Child Care Provider Application (Addendum) CC-200-A-FF Step 10: In the fourth column, give the relationship of all minor and adult children. In the last column, indicate with a check mark whether they are 18 or older.