Family and Dependent Assistance Fund Application

Family and Dependent Assistance Fund Application
Application Cycle: Fall 2025

Applications due by 5 pm EDT on November 17, 2025 for expenses incurred between April 18, 2025 and November 17, 2025.

All information is required and must be filled out completely for your application to be processed.
Name*

First NameLast Name
Preferred Email Address*
example@example.com
Yale UPI*
Bargaining Unit Job Title*
i.e., TF, RA; see your appointment letter
Documentation of Bargaining Unit job i.e. appointment letter or pay slip*

Cancelof
Start Date of Bargaining Unit Job*

DayMonthYear
Date
Are you still in this job?*

YesNo
End Date of Bargaining Unit Job*

MonthDayYear
Date
Department/School of Enrollment*
Degree Program of Enrollment*
Description of Eligible Expenses & Expense Documentation

Maximum reimbursement per cycle: $2,000
Total reimbursement requested:*
Were you eligible to receive any portion of the PhD student family subsidy during the academic term in which these expenses were incurred?*

YesNo
Please attach documentation for each eligible expense (copies of invoice or bill AND receipt or other proof of payment which matches the invoice or bill). The date of payment, recipient of payment’s full name, and amount of payment must be clearly visible on all documentation. Documents provided as part of this application will not be returned to applicants.
I am requesting reimbursement for expenses related to an in-home childcare provider.*

YesNo
Click here to download a form to be completed by your in-home childcare provider. Please have them complete this form and return to you. Then upload that form here to complete your submission.
File Upload*

Cancelof
Signature*

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Family and Dependent Assistance Fund Application

Description of Eligible Expenses & Expense Documentation