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Change Notification Form

    Are you transferring from a different board area in Texas? *


    Please Note:
    Child Care Services (CCS) will contact you within five (5) business days of receipt of the request.
    Address Change

    New Contact Information
    New Relationship Status
    (If selecting “Married”, provide a copy of the marriage certificate, the spouse’s social security number*, and the Spouse’s Date of Birth. If applicable, add spouse to Food Stamps case.)

    Cohabitation (Living Together)MarriedSingleSeparatedDivorcedWidowed

    New Dependent or add a Sibling
    (Parent will be required to provide documentation)


    Remove Child from Care

    Change of Income
    (Provide 2-4 check stubs or Wage Verification Form)

    IncreaseDecreaseAdditional Income (bonus, commission, etc.)Second Job (Primary Applicant)Second Job (Spouse)

    Change in Employment/Training
    (Includes Job Loss)

    Job LossNew Employment/Training

    Additional Employment

    Change in Hours
    (Provide a copy of work schedule)

    Work Hours

    Request a Reduction in Parent Share of Cost
    (Parent will be required to provide documentation)

    Temporary Incapacitation
    (Temporarily unable to work due to illness, injury, or maternity leave)
    (Parent will be required to provide documentation)

    Temporary Suspension of Child Care
    (Documentation may be required)

    REMINDER: Call CCS if you do not hear from them within five (5) days of submitting this form.

    Offices & Centers Closed | Workshops & Orientations Canceled

    FEBRUARY 18, 2021

    Our workforce centers and administrative offices are closed Thursday, Feb. 18, due to inclement weather. All events, including virtual workshops, orientations, tax preparation and other in-person appointments, have been canceled. If you have questions, please email us at, and our staff will respond as soon as possible.