This form allows you to initiate requests if you are already receiving services with the Early Learning
Coalition of Miami-Dade/Monroe. Please contact us at 305-646-7220 if you need assistance with this form or to schedule an in-office appointment.
Este formulario le permite iniciar solicitudes si ya está recibiendo servicios con Early Learning
Coalition of Miami-Dade/Monroe. Comuníquese con nosotros al 305-646-7220 si necesita ayuda con este formulario o para solicitar una cita en la oficina.
Fòm sa a pèmèt ou fè demann si w deja resevwa sèvis ak Early Learning
Coalition of Miami-Dade/Monroe. Tanpri kontakte nou nan 305-646-7220 si ou bezwen asistans ak fòm sa a oswa si ou ta vle pran yon randevou nan biwo a.
Tell us what you need help with.
Parent(s)/Guardian(s) are required to submit the request form completed and signed to the Early Learning Coalition (ELC) at least 72 hours before the date the suspended enrollment is
needed. If a request is submitted after the suspended enrollment date, you may be responsible for any charges that may be incurred.
It is the parent(s)/guardian(s) responsibility to make the childcare provider aware of
requested dates of absence. If your redetermination date falls during the period of the suspended enrollment, it is your responsibility to ensure that you complete your
redetermination timely. The ELC will not pay for any childcare costs if for whatever reason you are not able to re-establish your eligibility.
Parent(s)/Guardian(s) need to contact the ELC prior to returning your child to care to request a
new certificate. Failure to do so could result in the loss of your child care scholarship and you
may have to re-apply to be placed on the WaitList.
Please note that ELC will not pay your childcare provider for maintaining your child’s slot during
Parent(s)/Guardian(s) need to be aware that ELC cannot guarantee that your child (ren) will be
able to return to the same childcare provider or that funding will be available at the time of
After considering this matter carefully, I request that the Early Learning Coalition of Miami-Dade/Monroe County terminate childcare assistance for the child(ren) indicated below.
I understand that the ELC will process my appeal within ten (10) calendar days of receipt and that I will receive a copy of this completed form which will indicate the appeal decision; apart from statewide automated system interruptions that may delay file reviews. In the event the appeal is denied, I understand that within ten (10) calendar days of the appeal decision I have the right to request another review of my appeal which will conducted by the Coalition’s Chief Executive Officer or Chief Operations Officer.
I certify that under the penalty of perjury (a first-degree misdemeanor punishable by a definite term of imprisonment, not
exceeding one year and/or a fine not exceeding $1,000 pursuant to s. 837.012, or 775.082, or 775.083, F.S.) the
information given above is true and complete. I understand that it is against the law to give false information that will enable a person to receive services they are not eligible to receive. I understand that if it is discovered that I have not
been truthful with this information that I may be prosecuted for fraud.
Add the information on all the children that will be affected by this request.