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CCTA Childcare Reimbursement Request Form
DUE: June 28th, 2021
* Indicates required question
Name
*
Your answer
Email
*
Your answer
Are you presenting at CCTA?
Yes
No
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Are you an IEEE CSS Member?
Yes
No
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Please certify that you have read and understand the guidelines for reimbursement. (Link Here:
https://ccta2021.ieeecss.org/wp-content/uploads/2021/01/CSSChildCarePolicy-Approved-Jan2020.pdf
)
Yes
No
Clear selection
Please list your anticipated request with a short justification (e.g., babysitting expenses due to time zone differences) and the request amount to aid in determining how many grants can be awarded (max $500k per family).
Your answer
Is the dependent care for a child less than 12 years old?
Yes
No
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