Early Educator Health Benefits Application

Translate the Application
Open the application using the Google Chrome web browser:
  • Anywhere on the application form, right-click for a drop-down menu.
  • From the drop-down menu, select “Translate to.”
  • Choose the preferred translation language.
Para traducir el formulario al español u otro idioma:
  • Abra el formulario con el navegador web Google Chrome. Descarga Chrome aquí.
  • En cualquier lugar de este formulario, haga clic con el botón derecho y verá un menú desplegable.
  • Selecciona "Traducir a".
  • Elija el idioma al que le gustaría que se tradujera.
Application Instructions
ELIGIBILITY REQUIREMENTS
  • Educators who are currently working in an approved or licensed child care, Head Start, Parents as Teacher (PAT), and para-professionals/teachers in a school district working in a Pre-elementary classroom who are not part of a union.
  • Educators who are a member of the Alaska SEED Registry.
Complete the Application   
  • Complete the application below. Questions with an (*) require a response.  
  • Read the acknowledgement statement. 
  • Check the signature box and type your name. 
  • Submit the application. 
Application Help 
PART 1: APPLICANT & PROGRAM INFORMATION
A. Contact Information



(example: myname@gmail.com)


(example: 123 Main Street)








B. Demographics
This information is a requirement for enrollment.






C. Current Health Insurance Information


What is your portion of the yearly deductible and monthly premium?



D. Eligibility

Sorry, you are not eligible. You must be a paid employee of an approved or licensed child care, Head Start, Parents as Teacher (PAT), or para professional/teacher in a school district working in a Pre-elementary classroom and not be part of a union.




You're not eligible yet, but you can be!
To qualify, you need to be a current member of the Alaska SEED Registry.

Good news: registration is easy!

Visit the ServicePortal and login to become an Alaska SEED Registry member today.
PART 2: ACKNOWLEDGMENT STATEMENT & SIGNATURE
By submitting this application: 
  • I understand that it is my responsibility to maintain records and other documentation to support the use of the grant services received.
  • I understand that this grant may impact my individual taxable income. I will seek assistance as necessary from IRS.gov or a tax consultant for guidance.

  • I understand that this grant is subject to audit and monitoring via surveys, focus groups, or other methods. I agree to participate in these activities as necessary or as requested.
      
  • I certify that I work for a licensed child care program.
  • I hereby certify that, to the best of my knowledge, the provided information is true and accurate.


Submit button not working? You must be employed in an licensed child care program and be an active member of the Alaska SEED Registry to apply. You must also agree to the acknowledgement statement before submitting.