Subsidy Questionnaire | HealthyKidsPrograms

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Take this quick questionnaire to find out if you could qualify for child care assistance!

First Name

Last Name

Email

Do you live in NYS?

Are your children citizens or have satisfactory immigration status?

Do you meet one of the following?

Do you fall under one of the following income levels?

Family of 2 $67,490.17 Annual Income Limit

Family of 3 $83,370.21 Annual Income Limit

Family of 4 $99,250.25 Annual Income Limit

Family of 5 $115,130.29 Annual Income Limit

Family of 6 $131,010.33 Annual Income Limit

I attest that I have answered this form honestly and accurately.

Thanks for submitting! Our Subsidy Specialist will be in touch with the results of the questionnaire and next steps via email.

Email

Phone Number

Where are you located?

Message

Are you a new family to Healthy Kids? *

Yes

No

Would you like to receive updates, important notifications, and special offers via text message? *

Yes

No

Thanks for submitting!

📍2 Summit Court

Fishkill, NY 12524

845-330-0200

845-569-3925

Thanks for submitting!

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