Forms

Requirements

Parents are required to provide documentation to ensure they are eligible for the child care assistance they receive. In addition, permanent changes that may impact eligibility are also required to be reported within 14 calendar days. The following forms will assist parents in providing the documentation required to determine eligibility or ensure ongoing eligibility.

Parent Handbook

The parent handbook (PDF) is a detailed description of information about the program and your responsibilities while receiving child care services. The handbook is helpful because it gives you information to reference back to when you do not know what to do in certain circumstances.

Listing

Feel free to download or complete the following forms (as needed) and submit to your CCS caseworker:

• Child Care Waitlist Application - This form is used to apply for CCS services.
• Employment Verification Form - This form is required when parents have a new job or are new to the CCS program and do not have check stubs to verify employment.
• Employment Termination Form - This form is used to document when employment has ended.
• School Verification Form (PDF) - This form is required when parents are attending any type of educational program. A new form must be completed by the school at the beginning of placement of services and at yearly reviews.
• School Verification Form (Teen Parents) (PDF) - This form is required when a teen parent is attending a high school diploma or GED program. A new form must be completed at the beginning of the school year or any time there is a change in the teen parent’s school schedule.
• Veteran’s Self-Attestation Form (PDF) - This form is used to verify veteran’s status or you can submit a copy of DD214.
• Parent Acknowledgment - This form must be initialed, signed, and dated at time of placement for services and at yearly reviews.
• Consent to Release -This form must be completed at initial placement of services.
• Orientation to Complaint Form - This form must be completed at initial placement of services.
• Report of Change Form - This form is used to report changes that may impact eligibility including but not limited to income, employment, residence, etc.
• Transfer Request Form - This form is used to request a transfer to a different child care provider.
• Parents Choice of Provider Form - This form is used to request authorization of care at the parents chosen provider.