By signing below, as required by NIH per NOT-OD-21-177, I attest to the following:

• I am a UNM predoctoral/postdoctoral fellow, requesting childcare support.
• I am a full-time NIH NRSA fellow appointed on the IMSD NIH Institutional Training Award.
• I am requesting childcare support for the term of my appointment on the subject NRSA training award [enter number of months below].
• I am parent to and support eligible child/children – under the age of 13 or disabled and under the age of 18.
• I will inform the SOMREO Office immediately if the eligibility status of my child/children changes.
• I will engage the services of a licensed (regulated by state or local authorities) childcare provider/service.
• I understand that I may receive a $2500/budget period reimbursement of childcare costs during the term of my appointment if I provide the following documentation:
• Copy of Childcare provider/service license (regulated by state or local authorities) and
• Proof of payment to licensed childcare provider/service (e.g. payment receipt(s) and invoice(s)/statement(s)per year)