2. Once you are placed on the child care waiting list, you are required to update your status on the list every 90 days. If you do not update your name, you will fall off the list.
4. Please use this form to update your name on the list or report any changes to your household(i.e, family size, income, address or phone number change) that have occurred since you submitted your application.
6. First Name*
7. Last Name*
9. Date of Birth*
10. Phone Number*
12. Email Address
14. Has there been any changes to your household that have occurred since you submitted your application CCS?*
    -- Select One --YesNo
16. If yes, please explain:
18. Would you like to update your name on the child care waitlist?*
    -- Select One --YesNo
20. If yes, your name will be updated for 90 days from today's date. In order to ensure your name is not removed from the list, you must contact CCS every 90 days until you are placed into services.
22. If no, please indicate the reason you would like to be removed from the waiting list.
24. Questions or Comments
26. (If you have a question and need us to contact you back, please give us an email address or good phone number)
28. Please enter your initials and today's date below, to submit your information to Child Care Services.
30. Intials*
32. Today's Date*
Leave This Blank:


34. 1. Receive an email copy of this form.
35. Email address

    This field is not part of the form submission.

36. Submit

* indicates a required field