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Voucher Waiting List Form
Latino HL o Not Hispanic or Latino NH o Client Refused CR Gross Family Monthly Income Reason for Care o Employment o Training/Education o Other Children to be placed on the wait list attach a separate sheet for additional children Last Name First Name Birthdate Gender Child 1 MM/DD/YY oM oF The information contained on this form will be used to place your child/ren on the child care voucher wait list. Nyc.gov SAVE PRINT Page 1 of 1 Gladys Carri n Esq. Commissioner Dear Parent/Guardian Lorelei...
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