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					         Child Care Scholarship Pilot Program - Calendar Year 2008


The Child Care Scholarship Program is a pilot program designed to assist eligible full-time
faculty, administrative and professional staff, and professional research staff with child care
expenses for their children under the age of five (5) years. The awards will be made in
accordance with financial need based on household income and family size. Eligible child
care includes care provided in licensed family child care homes, day care centers, nursery
schools, or in your own home. One award is available per eligible family, per year.

If you are awarded a scholarship it will be distributed to you through an NYU Dependent
Care Flexible Spending Account (FSA). If you do not open an account for 2008, one will be
opened for you. You will file claims against the FSA account to receive your scholarship

Application Period and Notification

Scholarship applications for the period January 1, 2008 through December 31, 2008 will be
accepted from September 10 through October 10, 2007.

All applications and supporting information must be delivered in person or sent through U.S.
mail in the enclosed self-addressed envelope to:

               Child Care Scholarship Pilot Program
               Attn: Joyce Rittenburg
               194 Mercer Street - Room 404B
               New York, NY 10012

(Do not send or deliver applications to the NYU Benefits Office.)

Please note that all applications must be received by the October 10, 2007 deadline. If you
use U.S. mail, be sure to send it in time for the application to be received, not postmarked, by
October 10, 2007 or your application will be ineligible for a scholarship award.

All applications received by the deadline will be acknowledged via e-mail.

Notification of scholarship grants will be in writing and mailed to your home on or before
November 1, 2007. If you do not receive notification or you have a question about the
scholarship award, please contact Joyce Rittenburg at 212-998-9085.

Scholarships are awarded on an annual basis and applicants must reapply each year.


To be eligible for the Child Care Scholarship Program you must meet all of the following
conditions. Special circumstances will be considered on a case-by-case basis.

•   You must be a full-time faculty, administrative & professional staff, or professional
    research staff.

•   You must either be:
    (1) unmarried or
    (2) married with a spouse or partner who is:
        o Employed at least 50% part-time
        o A full-time student matriculated in a degree or certificate program; or
        o Disabled as defined by the Internal Revenue Code

•   Your dependent care expenses are incurred so you and, if applicable, your spouse or
    partner can be gainfully employed.

•   You must have had a total annual household income of less than $125,000 during calendar
    year 2006.

•   You must have a pre-kindergarten child(ren) who is (are) your legal dependent(s), as
    defined by IRS regulations, and for whom you are legally responsible.

    The child(ren) must share your home for at least half the year (if divorced, the child(ren)
    may live with your former spouse). Please note: “Child” includes biological, step,
    adopted, and foster children, any other children for whom you are the legal guardian or for
    whom you have court-awarded custody, and/or the children of your domestic partner.

    Please note: If your application involves the child(ren) of your domestic partner, an
    approved Statement of Domestic Partnership must be on file with the Benefits Office prior
    to the date you apply for the scholarship.

•   Your eligible dependent child(ren) must be born on or before the application deadline and
    be five (5) years old or younger on January 1, 2008. If your child turns age five (5) during
    the calendar year in which you are receiving a grant, reimbursements will continue to be
    paid for eligible child care expenses incurred for that child for the balance of the calendar
    year, up to the Child Care Scholarship amount.

•   Your caregiver must provide a Tax ID or Social Security Number and must report the
    child care income on their tax return.

•   Your caregiver cannot be your spouse, partner, or dependent.

Financial Need

To be considered for a grant from the Child Care Scholarship Pilot Program you must show
"financial need." The program determines financial need based on your family's annual
household income (less than $125,000) and family size. Those with lower household incomes
are deemed to have a greater need. Your household income is based on both of the following:

1. The Current Wages of the wage-earners in your household
   Current Wages are the taxable gross incomes shown on each household wage-earner's
   current pay stub, multiplied by the number of pay periods required to arrive at an annual
   taxable gross income amount. For self-employed wage earners, it is the taxable income
   estimated for purposes of mandatory quarterly tax payments.
2. The Adjusted Gross Income of your family.
   Adjusted Gross Income is the amount shown on lines 35 and 36 of Internal Revenue
   Service form 1040, or its equivalent on form 1040A, for the 2006 tax year. If you are
   married and file a separate tax return from your spouse, or you are in a domestic
   partnership, you will need to submit copies of all relevant tax returns, including those
   of your spouse or domestic partner, to permit NYU to determine Adjusted Gross
   Income for the household.

Determination of Financial Eligibility

A Child Care Scholarship Committee comprised of representatives from the Office of the
Vice Provost for Faculty Affairs and the Human Resources Division review all applications
through a confidential process that considers family income in determining the amount of the
award. Only one scholarship is available per family unit per year. You must reapply every
year to be considered for a child care scholarship. Eligibility for and the amount of the award
may vary from year to year.

To determine financial eligibility, the application requires financial information about all
sources of income for the individual(s) who are financially responsible for the child(ren) for
whom the award applies.

Depending on individual circumstances, you may be required to submit financial information
from the following individuals as part of your application:
   •   Birth and adoptive parents, regardless of marital status;
   •   Legal guardians;
   •   Stepparents, depending on the status of the non-custodial birth or adoptive parent.

Each individual who has financial responsibility for the child(ren), must provide the following
   •   Copies of salary pay stubs for the two (2) most recent pay periods
   •   Copies of federal income tax return(s) for 2006, including Schedule C if applicable.
       These forms are required whether you file jointly or separately.

How It Works

Child Care Scholarship grants are awarded according to financial need, as determined by New
York University, after taking into account the Adjusted Gross Income for your family and
your family size.

The scholarship grant is distributed to you through your Dependent Care Flexible Spending
Account and is therefore not included in your taxable income. If you qualify for a Child Care
Scholarship, you are responsible for understanding and complying with the rules and
regulations that govern New York University's Dependent Care Flexible Spending Account
plan. (For details, see the Benefits Resource Center at https://home.nyu.edu [Work tab])
Federal tax law has strict rules about the use of these accounts, including the “use it or lose it”
rule which requires that you forfeit any funds remaining in your Dependent Care Flexible
Spending Account at the end of the Plan Year and its Grace Period. These rules must be
followed without exception. For specific details on the IRS Rules governing dependent care
expenses that can be reimbursed from a Dependent Care Flexible Spending Account, see IRS
Publication 503, “Child and Dependent Care Expenses” found at www.irs.gov.

If you receive a Child Care Scholarship, you may also elect to make additional contributions
to your Dependent Care Flexible Spending Accounts from your wages on a pre-tax basis. If
you choose to do so, you need to be sure that the total of the scholarship plus your
contribution does not exceed the maximum annual total of $5,000 per family ($2,500, if you
are married and file taxes separately).

Please be sure to have your award letter in front of you when you make your voluntary
Dependent Care Flexible Spending Account election. Remember, during Open Enrollment
you will indicate the amount you want deducted from your paychecks only. Do not include
the amount of your scholarship as it will automatically be placed into your Flexible Spending
Account on January 1, 2008.

Your additional contributions, if any, may be used to reimburse dependent care expenses
incurred for the care of your dependent children eligible through the Child Care Scholarship
Program or for the care of your other eligible dependents where expenses are also eligible for
reimbursement from your Dependent Care Flexible Spending Account.

Your scholarship grant as well as any money you decide to contribute to a Dependent Care
Flexible Spending Account (which election is made during the fall Open Enrollment period)
is divided by 12 and credited to your Dependent Care Flexible Spending Account on a per-
pay-period basis throughout the plan year. Once the money is credited to your Dependent
Care Flexible Spending Account, you may request reimbursement by filing a claim with
United HealthCare, which administers the University’s Spending Account programs.

Dependent Care Flexible Spending Accounts and Tax Implications

A Dependent Care Flexible Spending Account allows you to set aside up to $5,000 in pre-tax
funds to help pay for child care expenses you incur to allow you and, if applicable, your
spouse to be gainfully employed. By enrolling in a Dependent Care Flexible Spending
Account, your Child Care Scholarship award (or a portion of it) may not be subject to federal
taxes. A Dependent Care Flexible Spending Account for your elective contributions from
your paycheck can only be set up during the Annual Benefits Open Enrollment Period or with
a change in family status.

Possible Tax Consequences

You should consult your tax professional before accepting a grant award. If you are awarded a
Child Care Scholarship, there may be tax implications if:
1. You are married but file taxes separately.
2. You have custody of your child(ren), but your ex-spouse claims them on his/her taxes [or
   you alternate claiming the child(ren) on your taxes].
3. Your spouse has no earned income for the tax year, even if looking for work and receiving
   unemployment compensation.
4. You are in the process of getting divorced or are legally separated.

How the Award Will Be Paid

This award will be paid to you on a reimbursement basis. UnitedHealthcare administers
dependent care claims reimbursements for the Child Care Scholarships based on the same
rules and regulations governing Dependent Care Flexible Spending Accounts.

When requesting reimbursement for qualifying child care expenses, you must provide the Tax
ID or Social Security Number of your child care provider and documentation that the expense
both meets eligibility requirements and has already been incurred. “Incurred” means you
have both paid for and received the service. The total annual award amount accrues on a
monthly basis, and reimbursement is limited to the portion of your award that has actually
accrued as of the date your reimbursement request is processed.

All rules governing the NYU Flexible Spending Account Plan and the NYU Dependent Care
Flexible Spending Account Plan are incorporated into these guidelines by reference. Should
any conflict arise between these guidelines and the provision of either of the above-mentioned
Plans, the Plan Administrator of the NYU Flexible Spending Account Plan, or his or her
authorized delegate, shall resolve such conflict, and any such decision by the Plan
Administrator shall be final and binding.

No scholarship recipient has any vested right in any grant amount awarded or credited to his
or her Flexible Spending Account. All amounts credited remain the property of NYU until a
reimbursement check is issued by United Healthcare.

                    Calendar Year 2008

Be sure to read the program description about NYU’s pilot Child Care Scholarship Program.
Please complete the application in blue or black ink and print clearly.



_____________________________________                  ____________________________________
NYU ID                                                 DATE OF HIRE



______________________________________                 ____________________________________
E-MAIL ADDRESS                                         WORK PHONE

______________________________________                 ____________________________________
SCHOOL/UNIT                                            DEPARTMENT



□ Faculty              □ Administrative Professional          □ Professional Research Staff


□ Single       □ Married       □ Domestic Partner Relationship




IF YES, WHERE? __________________________________________________________________

 Please provide information about all of the individuals in your household, including your children.

 Please Note: If your child five (5) years or younger is not enrolled in the NYU Benefits plan, please include a
 copy of their birth certificate.

NAME                               RELATIONSHIP     BIRTHDATE        ENROLLED IN      TAX             SOCIAL SECURITY
(Last, First, Middle Initial)      TO APPLICANT     (MM/DD/YYYY)     NYU BENEFITS     DEPENDENT       NUMBER
                                         Self                        □ YES □ NO       □ YES □ NO

                                                                     □ YES □ NO       □ YES □ NO

                                                                     □ YES □ NO       □ YES □ NO

                                                                     □ YES □ NO       □ YES □ NO

                                                                     □ YES □ NO       □ YES □ NO

 Please provide information about your eligible child’s child care.

 (Last, First, Middle Initial)    INFORMATION                      SOCIAL SECURITY   CARE                  CARE
                                                                   OR EMPLOYER ID
                                  Name:                                              Hours/day:            $
                                                                                     Days/week:            □ weekly
                                                                                                           □ monthly
                                  Name:                                              Hours/day:            $
                                                                                     Days/week:            □ weekly
                                                                                                           □ monthly
                                  Name:                                              Hours/day:            $
                                                                                     Days/week:            □ weekly
                                                                                                           □ monthly

                                         Complete, Date, and Sign the Other Side

                                                    IMPORTANT NOTICE:
             Please confirm that the application is completed in its entirety. Date and sign the back of the
             application. Applications must be mailed in the self-addressed envelope through U.S. mail or hand
             delivered to 194 Mercer Street, Room 404B. All applications must be received no later than 5 p.m. on
             October 10, 2007.

             Be sure to include all information requested in Part Three. Incomplete applications will be disqualified
             and the request for a Scholarship will be denied.

Note: As part of our application process, we need to review personal information. Be assured we keep
this information strictly confidential and securely stored.
Check off each of these items as you enclose them with your application:

□ Copies of current New York University employee pay stubs from two pay periods.
□ Copies of spouse/domestic partner pay stubs from two pay periods or similar information.
□ Completed and signed copies of yours and your spouse/domestic partner’s 2006 Federal Income
  Tax form 1040 or 1040A (front and back).
□ A copy of IRS Schedule C, if your spouse/domestic partner is self-employed.
Estimated Adjusted Gross Income To calculate your estimated gross salary/wages, multiply your
federal taxable gross wages for one pay period (as shown on your paycheck stub) by the number of
pay periods in a 12-month period (for example, at NYU there are 12 pay periods per year).
                             Federal Taxable            # of Pay Periods         Projected Adjusted Gross
                             Gross Wages Per Pay        Per Year                 Salary/Wages For 2006
NYU Faculty/Staff
                             $                     X            12          =

Spouse/Domestic Partner
                             $                     X                        =

                                                                                 Total $

Statement of Understanding — By signing below, I certify that I have attached all applicable tax forms
and other required income source documents. I understand I must notify the Benefits Office of any family
status changes (i.e., dissolution of marriage or domestic partnership) or other changes which could affect
my child custody responsibilities or eligibility to participate in or receive reimbursements from a
Dependent Care Flexible Spending Account during the plan year I receive a Child Care Scholarship. I
certify under penalty of perjury that all statements and documentation relating to this application are true
and accurate. I understand that incomplete or inaccurate information may adversely affect my eligibility
under this Program and could result in my being required to repay to New York University any funds
awarded and/or my being subject to disciplinary action up to and including termination.

_______________________________________                              ______________________
Employee Signature                                                          Date

Return this application and all required supporting documentation in the enclosed self-
addressed envelope to:
         Child Care Scholarship Pilot Program
         New York University
         Attn: Joyce Rittenburg
         194 Mercer Street, Room 404B
         New York, NY 10012

Special Notes:
•   You may need extra postage.
•   Applications will not be accepted by fax or e-mail.
•   Questions about completing this form? Call (212) 998-9085.
•   Please make sure that all the items listed in Part Four above are enclosed and that you have signed
    and dated the application.


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