è For Parents
è For Providers of Child Care
è For the Community
Center-Based Program Update
Part of a state-wide network of referral agencies, Child Care Connection serves Mahoning, Medina, Portage, Summit, Stark, and Trumbull Counties in Ohio.
The form below must be completed and submitted before you end your internet session. Simply tab, type your information, and the click the [Submit] button.
Click here if you want to save it to your computer and complete it later in Microsoft Word.
Click here if you want to print out the PDF version and write in your answers.
Program Information Form
List the Elementary school(s) your program serves?
Sliding Fee Scale
Program Director's Name
Click on the button below to Submit your form to:
Child Care Connection
703 South Main Street # 211
Akron, Ohio 44311