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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
3901 Twin City Highway
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
Address:   City:  
State:   Zip Code:  
       
Home Number:  
Cellular Phone:  
E-Mail Address:  
   
  1. 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
  2. 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.
Effective Date: (mm/dd/yyyy)
List Additional Income
(if applicable)
   
Start Date: (mm/dd/yyyy)
Last Day at Previous Employer/Training: (mm/dd/yyyy)
   
Name of Employer:
Date: (mm/dd/yyyy)
   
Start Date: (mm/dd/yyyy)
Days in Week:
Work Hours:(hh:mm) to
   
Reason for the reduction:  
   
Note: Backup documents may be required to verify your need for assistance.