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Get La Ccap 2 2018-2024

S responsible for paying child care costs. PLEASE PRINT ALL INFORMATION Last Name: First Name: Middle Initial: Home Address Street: Apt. No.: City: Parish: ZIP: Mailing Address Street: P.O. Box: City: Parish: Telephone Number: Home: ( ZIP: ) Work: ( ) Other Phone: ( Are you considered homeless according to McKinney Vento Homeless Assistance Act? Are you participating in a Transitional Living Program? Yes Yes ) No No Do you certify that your family assets do not exceed $.

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