Contact us

Beaumont Location
510 Park Street, Suite 215
Beaumont, Texas 77701
Phone: 409-835-1411
Fax: 409-838-4048
cccs@workforcechildcare.org

Port Arthur Location
4680 FM 365
Port Arthur, Texas 77642
Phone: 409-962-1236
cccs@workforcechildcare.org

REPORT A CHANGE

If you receive child care assistance, or on the waiting list and you have a change to report, please fill out the form below:

First Name:*
Last Name:*
Last 4 digit of Social Security #:
Spouse Name ( if applicable):
Contact Number:*
E-mail Address:
Date of Birth:*	(mm/dd/yyyy)

Requested Change: please check the appropriate box or boxes below

Mailing Address
Physical Address

New Contact Numbers

Change to members in the household (such as a new baby, change in marital status,etc.)

Request - New Child Care Provider

Child care authorizations typically begin at the beginning of each month. If your situation is an emergency, please contact our office at 409-835-1411
You must visit & complete all of the child care forms before it can be approved

Note: Please do not start child care at the new facility until you have heard from CCCS. We must authorize child care at the new facility.

Change of Income

Increase

Decrease

Additional Income

Effective Date:	(mm/dd/yyyy)
List Additional Income (if applicable)

Change in Employment/ Training

Start Date:	(mm/dd/yyyy)
Last Day at Previous Employer/Training:	(mm/dd/yyyy)

Additional Employment

Name of Employer:
Date:	(mm/dd/yyyy)

Change in Hours

Temporary Reduction of Co-payment

Reason for the reduction:

Note: Backup documents may be required to verify your need for assistance.