Partner Up! Business Intake

In this form, businesses provide contact information and information about the employees who will be receiving child care slots through the Partner Up! program.

Contact Information

The business fields should match the information provided on the Business Application.

Business Name

Business Street Address

City

State

Postal Code

County where business is located

Business Contact

The following contact information is for the person who will serve as the general contact for the business. The contact should match the information submitted on the Business Application.

Business Contact First Name

Business Contact Last Name

Business Contact Phone Number

Business Contact Email

Billing Information

Billing Contact

First Name

Last Name

Email Address

Billing Address

Same as Business Location Address

Billing Street Address

City

State

Postal Code

Employee Information

Enter the following information for EACH employee that will benefit from Partner Up! Click the plus symbol () to the right of the section to add more fields in order to enter information for another employee. If an employee is no longer participating in the program, for any reason, please mark "No, this employee is not active in Partner Up!"

Note: Please do not list too many employees. The total number of slots is per child NOT per employee.

Employee is currently active in the Partner Up! grant program.	Employee First Name	Employee Last Name	Employee Email	Operations
Employee is currently active in the Partner Up! grant program. Yes No	Employee First Name	Employee Last Name	Employee Email

more items

Partner Up! Business Intake

Contact Information

Billing Information

Employee Information

DCF-F-5706-E (N. 01/2024)