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Jessie Kim
Jessie Kim
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The following is the subsidy application for
Jessie Kim
. Click to approve, deny or request more information.
Proof of income
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September Paystub.docx
2024 W2 Document.pdf
Enrollment details
Desired start date
01/30/2025
Schedule
Monday-Thursday
7:00 am - 3:30 pm
Documentation
Documentation of incapacitation
Dr.Ayers_Incapacitation.docx
Proof of birth of child
Childs_BirthCertificate.jpg
Photo identification of child
Childs_ID.pdf
Child information
Child name
Childs name
Gender
Female
Birthday
09/01/2022
Medical conditions
Asthma
Address
918 Waterfall Lane
City
Portland
State
OR
Zip Code
94109
Parent information
Parent name
Alex Kim
Email
AlexK@gmail.com
Phone
292-192-2929
AN
Andy Smith
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Jessie Kim
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You will be notified when payment is approved.
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Jessie Kim
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We will notify the provider of the status change
The provider will see the reasons it was denied
If they make corrections they can resubmit their claim as a new claim
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Jessie Kim
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