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Change Notification Form


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)

BirthOther

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)



MondayTuesdayWednesdayThursdayFridaySaturdaySunday
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)

Other
REMINDER: Call CCS if you do not hear from them within five (5) days of submitting this form.
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Workforce Solutions for the Heart of Texas is one of 28 local workforce development boards in Texas that partners with the Texas Workforce Commission (TWC) to provide workforce solutions to employers and job seekers. The Heart of Texas region includes Bosque, Falls, Freestone, Hill, Limestone and McLennan counties. 

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Workforce Solutions for the Heart of Texas is one of 28 local workforce development boards in Texas that partners with the Texas Workforce Commission (TWC) to provide workforce solutions to employers and job seekers. The Heart of Texas region includes Bosque, Falls, Freestone, Hill, Limestone and McLennan counties. 

   

Workforce Solutions for the Heart of Texas is one of 28 local workforce development boards in Texas that partners with the Texas Workforce Commission (TWC) to provide workforce solutions to employers and job seekers. The Heart of Texas region includes Bosque, Falls, Freestone, Hill, Limestone and McLennan counties. 

   

Copyright © 2020 Heart of Texas Workforce Development Board, Inc. The Heart of Texas Workforce Development Board, Inc. is an equal opportunity employer/program and auxiliary aids and services are available upon request to individuals with disabilities. TTY/TDD via RELAY Texas service at 711 or (TDD) 1-800-735-2989 / 1-800-735-2988 (voice).

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