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Child Care Services Change Form

  1. If you are currently receiving child care services or you are on the waiting list for services, you have 14 days to report any changes in eligibility to Child Care Services.

  2. Please complete the following information:

  3. Are you on the waiting list for services?

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

  5. Report Changes *

    Please select ALL changes you want to report

  6. Information of New HH Member

  7. Disclaimer

  8. If there is a new person in the household, the following documents may be needed

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

  9. If you have any other changes that need to be reported to CCS or you need immediate assistance, please give us a call at 325-795-4200.

  10. Note: Please do not start your child(ren) at the new facility until you have heard from CCS. We must authorize child care at the new facility.

  11. An Equal Opportunity Employer / Program Auxiliary aids and services are available upon request to individuals with disabilities.

  12. Leave This Blank:

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