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Child Care Services Change Form

  1. Are you on the waiting list for services?

  2. Would you like to update your name to the waiting list for services?

  3. Report Changes *

    Please select ALL changes you want to report

  4. Information of New HH Member

  5. -a copy of verification of citizenship
    -a copy of the social security card* voluntary
    -Income documentation he/she is receiving.

  6. Leave This Blank:

  7. This field is not part of the form submission.