Parents please continue to contact ELRC Region 18 with questions regarding your eligibility by calling 215-382-4762 or sending an email to firstname.lastname@example.org.
- ELRC Region 18 remains closed to the public.
- ELRC Region 18 has drop boxes available at our Northeast Philadelphia office (2361-2373 Welsh Road, Philadelphia, PA 19114) and in our West Philadelphia office (5548 Chestnut Street, Second Floor, Philadelphia, PA 19139). Hours are Mondays through Fridays 8:00 am to 5:00 pm.
- Need to complete a form for ELRC Region 18? Scroll down for a list of available ELRC Region 18 forms. Forms can be printed or completed online and submitted electronically.
- New applications and Redeterminations are still being processed. Make sure to submit your documentation in person at one of our drop boxes or electronically (email@example.com).
- Need help finding a provider? Search the online childcare tool or call us at 215-382-4762.
- Remember to utilize COMPASS to submit your redetermination or new application by visiting: compass.state.pa.us. ·You can also use COMPASS to apply for cash assistance, food stamps (SNAP) benefits, medical and more!
- Supporting documentation can be sent electronically via fax (215-382-1199) or via email (firstname.lastname@example.org).
Printable ELRC Client Forms
Please click on the ELRC client form to print. Completed forms can be sent via email (email@example.com), fax (215-382-1199) or mail (ELRC Region 18, 2361-2373 Welsh Road, Philadelphia, PA 19114).
- FPIG – Co-pay Chart
- Anticipated Self-Employment Income and Schedule of Care
- Authorization for Release of Information
- Authorization for Release of Information Español
- Cash Earning Form
- Class-Training Schedule Verification
- Education Schedule Verification
- Employment Verification Form
- Employment Verification Form Español
- Medical Assessment Form
- Notice of Privacy Practices
- Parent Schedule Review
- Self-employment Schedule of Care
- Self-Employment Verification
- Self-Employment Verification Español