New Submission

Parent/Guardian First Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Parent/Guardian Last Name*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Parent/Guardian Phone*field type single line
Input blocked. Maximum character limit of 4000 characters reached.
Do you currently have an open case with Child Care Services?*field type radio button
Do you currently have an open case with Child Care Services?yesno
Social Security Number (Input Numbers Only)field type single line
Input blocked. Maximum character limit of 4000 characters reached.
TWIST IDfield type single line
Input blocked. Maximum character limit of 4000 characters reached.
Email Address*field type email
Child Care Services sends all communication through Email. It is VERY important to enter a valid email and check that email on a regular basis to avoid missing communication which could cause an interruption or delay in your services.
I need to report a change in:*field type checkbox
I need to report a change in:SuspensionIncomeScheduleFamily SizeMailing AddressPhysical AddressPhone NumberOther

Income Threshold

Please Explain?*field type multi line
Proof of Income*field type file upload
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Please Explain?*field type multi line
Schedule*field type file upload
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Please Explain?*field type multi line
Proof of Family Size*field type file upload
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A new application is required to be completed with any change in family size.
Click Here to Complete New Application

Please Explain?*field type multi line
Proof of Mailing Address*field type file upload
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Mailing Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country

Please Explain?*field type multi line
Proof of Address*field type file upload
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Physical Address*field type address
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country

Phone Number (Input Numbers Only)*field type single line
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Other - Add any Additional Documentationfield type file upload
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Signature*field type signature
Datefield type date
Date will be captured on form submission
By signing electronically, I agree that the electronic signatures appearing on this agreement are the same as handwritten signatures for the purposes of validity, enforceability and admissibility.

Workforce Solutions South Plains is an equal opportunity employer/programs. Auxiliary aids and services are available upon request to individuals with disabilities. Relay Texas: 711 (voice); 800-735-2989 (TDD); or Relay Texas Spanish 800-662-4954.

Sourcefield type single line
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LINKEntryIDfield type single line
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LinkFirstNamefield type single line
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LinkLastNamefield type single line
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LinkTWISTIDfield type single line
Input blocked. Maximum character limit of 4000 characters reached.