Assistance through this program will be paid through the standard payroll system and considered taxable income by the Internal Revenue Service.
* indicates required fields.
Please mark the appropriate reimbursement period deadline for this claim: *
11/30/2019 (payments will be made on December 21, 2019)
02/28/2020 (payments will be made on March 21, 2020)
04/30/2020 (payments will be made on May 21, 2020)
06/30/2020 (payments will be made on July 21, 2020)
08/31/2020 (payments will be made on September 21, 2020)
Correct, no changes to report.
There are changes to report. Please email me for further details.
N/A - I am a single parent
Employed at least 75% FTE (30 hours a week)
A full-time student
Name of Service Provider #1: *
Dates of Service: *
Requested Reimbursement Amount: *
(If Applicable) Name of Service Provider #2:
(If Applicable) Dates of Service for Provider #2:
(If Applicable) Requested Reimbursement Amount for Service Provider #2:
Please compose an email to WorkLifeFinAssist@stanford.edu. Type "Secure:" at the start of the email subject line. Include -
- The names and ages of eligible children in your household, ages 5 and younger.
- Attach receipts using the following guide:
For claims that include center-based care, please provide a copy of your most recent account statement that shows payments that have been submitted to the vendor.
If you have an in-home child care provider, please use the sample receipt that was provided on the previous page in order to capture all of the necessary details. Please note that the child care provider must sign and date the form.
If you have questions, please contact WorkLifeFinAssist@stanford.edu for additional support.
Please skip. Do not fill this out.