To apply for financial assistance, an applicant shall submit to the Department an application on the form that the Department requires. The application shall include: The identity and location of the family child care provider; An itemization of known and estimated costs; The total amount of funds required by the family child care provider to comply with State and local regulations; The funds available to the applicant without financial assistance from the Department; The amount of financial assistance sought from the Department; A statement from the family child care provider on how the grant funds will be used; Information that relates to the family income of the grant applicant; and Any other relevant information that the Department requests.