Health & Safety Grant Application Form

Reimbursement Application 2024-2025

Funded by the California Department of Social Services (Incomplete applications cannot be processed).

If you have taken an EMSA approved Preventative Health Practices training course or have renewed your CPR/First Aid training from July 1, 2024 through June 30, 2025 and are a licensed family child care provider, an individual child care center staff member or a licensed-exempt child care provider, you are eligible to apply for the scholarship grant.

From July 1, 2024 through June 30, 2025 or until the funding runs out, the State of California will continue to make Health & Safety scholarship funding available for up to $150.00 per individual. Each child care provider will be reimbursed for the cost of the training less $10.00. (Examples: $100.00 for cost of training - $10.00 = $90.00 reimbursement). The Health & Safety scholarship funding is to be used for:

CPR/First Aid training from July 1, 2024 – June 30, 2025.
Preventative Health Practices Training from July 1, 2024 – June 30, 2025.

The Health and Safety training funds are being used to provide scholarships to assist licensed center-based staff, licensed family child care providers, license-exempt child care providers and in-home providers in completing prescribed training on preventative health practices per AB243.

At least one director or teacher at each child care center and each licensee of a family day care home shall have 16 hours of training on preventive health practices. This grant will reimburse a family child care licensee and three adult assistants (small FCC) or 5 adult assistants (large FCC) per funding year (July 2023-June 2024). This grant will also reimburse 10 individual staff members of a child care center per funding year.

The training includes pediatric CPR, pediatric first aid; recognition, management, and prevention of infectious diseases, including immunizations, and prevention of childhood injuries. The training may also include sanitary food handling, child nutrition, emergency preparedness and evacuation, caring for children with special needs, and identification and reporting of signs and symptoms of child abuse.

The Pediatric CPR and Pediatric First Aid must be taken from an EMSA approved training institution or EMSA exempt (i.e. American Red Cross or American Heart Association) training entity in Ventura County.

Individuals can apply for reimbursement one time during the funding cycle.

The funding is available on a first come, first serve basis. Classes must be completed, and application submitted by June 02, 2025.

If you have any questions, please call Danielle B. Sevic at (805) 561-7920.

Name*

First NameLast Name

Telephone Number*

Please enter a valid phone number.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Social Security/Employer Identification Number*

Email*

example@example.com

Are you Licensed?*

Licensed CenterLicensed Family Child CareLicensed-Exempt Center Base StaffFamily, Friend or Neighbor Child Care ProviderFamily, Friend or Neighbor Child Care Provider caring for child in the child's home.

Position: Position*

Name of Facility: Name of Facility*

License # :*

9-digit #

Facility Address:*
Street Address* City* State* Zip*

Name of family you provide care for:Name of Family*

Name of Training Institution: Training Institution*

Name of Course: Name of Course*

Number of Hours: Number of Hours*

Date of Training: Date*

Fee Paid (per individual):*

Enter dollar amount

Are you seeking reimbursement for multiple individuals?*

YesNo

Total number of individuals you are requesting reimbursement for:

Please provide name(s) of individuals you are requesting to be reimbursed below:*

Below are the steps on how to fill out the section above.
1. Click on the " + " to add more fields.

2. Click on " x " to remove a field.

***Important! Please Submit (must include all documents for all individuals listed or application will not be processed)***

Copy of front & back of issued card and/or Certificate of Completion with valid Certificate ID.

Individual receipt of payment from vendor for class with participant’s name. Example: Invoice from the American Heart Association

How to add a upload a file on a computer.
1. Click on "Browse Files"
2. Navigate to where you saved the file, select the file you want to upload.
3. Then select "Open"
4. Your document(s) will appear below.

File Upload*

Employee Name

First NameLast Name

Amount approved for:

Total Cost of Training:

Minus required Copay:

Total amount approved:

Health & Safety Grant Application Form

License Information:

Training Information: