Family Child Care Provider Form

Full Name

Email Address

Primary Phone Number

Zip Code

State

Select nearest installation Select nearest installation *AF ACADEMY COBEALE AFB CAALTUS AFB OKBARKSDALE AFB LACANNON AFB NMDOVER AFB DEDYESS AFB TXEDWARDS AFB AKEGLIN AFB FLEIELSON AFB AKELLSWORTH AFB SDFAIRCHILD AFB WAFE WARREN AFB WYGOODFELLOW AFB TXGRAND FORKS AFB NDHANSCOM AFB MAHILL AFB UTHOLLOMAN AFB NMHURLBURT FLJB ANACOSTIA-BOLLING (JBAB)JB ANDREWS MDJB CHARLESTON SCJB ELMEN/RICH (JBER) AKJB MCGUIREDIXLAKEHURST NJ (JBMDL)JBLE FT EUSTIS VAJBLE LANGLEY VAJBSAKADENAKEESLER AFB MSKIRTLAND AFB NMLAUGHLIN AFB TXLITTLE ROCK AFB ARLOS ANGELES AFB CALUKE AFB AZMACDILL AFB FLMALMSTROM AFB MMAXWELL AFB ALMCCONNELL AFB KSMINOT AFB NDMISAWAMOODY AFB GAMT HOME AFB IDNELLIS AFB NVOFFUTT AFB NEOSAN ABPATRICK SFB FLPETERSON SFB CORAG ALCONBURYRAF LAKENHEATHRAF CROUGHTONRAMSTEINROBINS AFB GASCOTT AFB ILSEYMOUR JOHNSON AFB NCSHAW AFB SCSHEPPARD AFB TXSPANGDAHLEMTINKER AFB OKTRAVIS AFB CATYNDALL AFB FLVANCE AFB OKVANDERBERG AFB CAWHITEMAN AFB MOWRIGHTPATTERSON AFB OHYOKOTATEST

Are you 18 years of age or older? Are you 18 years of age or older? Yes No

Do you live within 30 miles of an Air Force or Space Force installation? Do you live within 30 miles of an Air Force or Space Force installation? Yes No

Are you and members of the household ages 18+ willing to participate in a background check? Are you and members of the household ages 18+ willing to participate in a background check? Yes No

Do you have proof of high school education (diploma or GED)? Do you have proof of high school education (diploma or GED)? Yes No

I understand the onboarding process may take up to six months. I understand the onboarding process may take up to six months. Yes No