nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image nivo slider image

Child Care Assistance Program

Please read through the list of forms below, to find the one that bests fits your needs as a parent or provider. If you have any questions about any of these forms, please contact us at 1-800-676-2805 and someone will be available to assist you.

Child Care Assistance Application – Complete this form if you are a new applicant or if your child care case has been cancelled for over 30 days. Please also download the Application Checklist to help ensure timely processing of your application.

EMAIL Agreement Email Agreement РTo receive e-mail notices of case updates-parents and providers must sign-up for these updates. You may sign-up for e-mail notification by completing this form.

If you are needing a Redetermination, Change of Provider, Change of Information or Wage Verification form, please contact Community Child Care Connection, Inc. to request the necessary form.

Letter of Employment Requirements Form – Your employer will need to complete this form if you have been employed less than 30 days and/or are unable to submit 2 current, consecutive and complete check stubs.

Self-Employment Records Form – If you have been self-employed less than one year and have not yet filed income taxes 3 full months of self employment records may be completed.

Child Care Rate Certification Form – This form is for providers who need to update their current child care rates.

Telephone Billing Agreement – After completing this form and submitting it to CCCC, providers receive a password in the mail, which allows providers to call in their billing certificates each month rather than mailing them to CCCC.

The following 2 forms are Change of Address Forms.
Attention Clients and Providers, please make sure you select the appropriate form.

Client Change of Address Form

Provider Change of Address Form

How do I download a PDF?