Child Care Assistance Application

Standard Child Care Eligibility
Screening & Application

Welcome! We currently have a waiting list for our program. Please click the "Next" button below to proceed to the eligibility screening section.

Priority of Service

If you answer "Yes" to any of the questions below, you may receive priority among our list of applicants for child care services. Supporting documentation will be required for selected priority statuses. If none of the statements below apply to you, click the "None of the above statements apply to me" option.
Please select all that apply so we can determine if you should receive priority services.*

Are you a qualified veteran?Are you a spouse of a qualified veteran?Are you a current or former foster youth between the ages of 14-23?Are you a teen parent (age 19 and younger)?Are you a parent of a child with a disability who needs child care?Are you currently receiving assistance or services through Child Protective Services?Are you homeless? Children and youth who lack a fixed, regular, and adequate nighttime residence are considered homeless under the McKinney-Vento Homeless Assistance Act and may be eligible for Child Care Services.None of the above statements apply to me.
NOTE: You will be required to submit the following documents if you check the corresponding box above:
- Qualified Veteran: You will need to provide a DD214 or self-attestation form
- Spouse of Qualified Veteran: You will need to provide a DD214 or self-attestation form
- Current or Former Foster Youth: You will need to provide a letter from the Texas Department of Protective and Regulatory Services
- Teen Parent: Your school counselor must complete a Verification of School Enrollment Form
- Parent of a Child with a Disability: You will need to provide medical documentation
- Child Protective Services Assistance: You need to provide a copy of your current Safety Plan from CPS.

Parent Information

Please fill out the information in this section according to the parent who is applying for child care.
Gender*
First Name*
Middle Initial
Last Name*
*Social Security Number
This information will help our staff quickly process your application.
Date of Birth:*

MonthDayYear
Marital Status*
Race*
Hispanic/Latino*
Parent Contact Information
Main Phone Number*
Provide the number you preferred to be reached at.
Email:*

Confirmation EmailConfirm email address
What is your preferred method of communication? Check all that apply.*

EmailHome PhoneCell Phone
Parent Physical Address*

Physical Street Address (ex: 1234 Waco St.)

Apartment/Unit Number

CityState

Zip
Is your mailing address the same as your physical address?

YesNo
Parent Mailing Address*

Physical Street Address (ex: 1234 Waco St.)

Apartment/Unit Number

CityState

Zip
*Providing your social security number is optional.

Parent Employment & School Information

Please fill out the information in this section according to the parent who is applying for child care. Additional fields may display based on your responses.
Are you currently employed?*
How many jobs do you currently have?*
Are you currently enrolled in school/training?*
Are you currently working or attending school/training or a combination of both for at least 25 hours per week?*

YesNo

Applicant Employer 1 Information Section
Employment Information
Employer Name*
Employer Phone Number*
Employer Address*

Physical Street Address (ex: 1234 Waco St.)

Street Address Line 2

CityState / Province

Zip
Date of Hire*

MonthDayYear
Hours Worked Per Week*
Hourly Pay Rate $:*
Pay Frequency*

Applicant Employer 2 Information Section
Employer 2 Information
Employer Name*
Employer Phone Number*
Employer Address*

Physical Street Address (ex: 1234 Waco St.)

Street Address Line 2

CityState / Province

Zip
Date of Hire*

MonthDayYear
Hours Worked Per Week*
Hourly Pay Rate $:*
Pay Frequency*

Applicant Employer 3 Information Section
Employer 3 Information
Employer Name*
Employer Phone Number*
Employer Address*

Physical Street Address (ex: 1234 Waco St.)

Street Address Line 2

CityState / Province

Zip
Date of Hire*

MonthDayYear
Hours Worked Per Week*
Hourly Pay Rate $:*
Pay Frequency*

Applicant School Information Section
School Information
Name of School*
School Address*

Physical Street Address (ex: 1234 Waco St.)

Street Address Line 2

CityState / Province

Zip
Date of Enrollment*

MonthDayYear
Current Number of Hours Enrolled*
Complete the next two fields if you are enrolled in a college or training program. Note: Parents are not eligible for child care assistance for the pursuit of education beyond an Associate's (2-year) Degree.
Training/Certification or Degree Parent is Pursuing
Total Credit Hours Completed

Applicant Employment/School Information Section Collapse Stopper

Household Information

Please fill out the information in this section based on the household of the parent applying for child care.
Total Number of Persons in Household*
Please include parent/caretaker, spouse or significant other, all children, and any other dependent persons.
Is your spouse/significant other living in your household?*
Do you or your spouse/significant other receive Food Stamps?*

YesNo

Spouse/Significant Other Information

You are seeing this section because you indicated that a spouse/significant other lives in your household. Please fill out the information in this section according to the spouse/significant other living in the household.
First Name*
Last Name*
*Social Security Number
Date of Birth:*

MonthDayYear
Gender*
Marital Status*
Race*
Hispanic/Latino*
Spouse/Significant Other Contact Information
Main Phone Number*
Email:*

Confirmation EmailConfirm email address
Is your spouse/significant other's address the same as yours?*

YesNo
Physical Address*

Physical Street Address (ex: 1234 Waco St.)

Apartment/Unit Number

CityState

Zip
Mailing Address*

Physical Street Address (ex: 1234 Waco St.)

Apartment/Unit Number

CityState

Zip
Spouse/Significant Other Employment & School Information

Please answer the following employment and school status questions in regard to the spouse/significant other living in the household with the applicant.
Is your spouse/significant other currently working?*
Is your spouse/significant other currently enrolled in school/training?*
Is your spouse/significant other currently working or enrolled in school/training or a combination of both for at least 25 hours per week?*

YesNo
Please explain why your spouse/significant other neither works nor attends school or training:*
*Providing your social security number is optional.

Spouse/Significant Other Employment Information Section
Employer Information

You are seeing this section because you indicated that your spouse/significant other is currently employed. Please fill out this section according to your spouse/significant other's employment information.
Employer Name*
Employer Phone Number*
Employer Address*

Physical Street Address (ex: 1234 Waco St.)

Street Address Line 2

CityState / Province

Zip
Date of Hire*

MonthDayYear
Hours Worked Per Week*
Hourly Pay Rate $:*
Pay Frequency*

Spouse/Significant Other School Information Section
School Information

You are seeing this section because you indicated that your spouse/significant other is currently enrolled in school/training. Please fill out this section according to your spouse/significant other's school/training information.
Name of School*
School Address*

Physical Street Address (ex: 1234 Waco St.)

Street Address Line 2

CityState / Province

Zip
Date of Enrollment*

MonthDayYear
Hours Enrolled*
Complete the next two fields if your Spouse/Significant Other is enrolled in a college or training program. Note: Parents are not eligible for child care assistance for the pursuit of education beyond an Associate's Degree (2-year degree).
Training/Certification or Degree the Spouse/Significant Other is Pursuing
Total Credit Hours Completed

Spouse/Significant Other Employment/School Section Collapse Stopper

Children Who DO NOT Need Care Information

You are seeing this because you selected "yes" to having other children living in your household who DO NOT need child care. Information fields for the number of children selected will display.
How many children do you have in your household who DO NOT need child care?*

Children who DO NOT Need Care Child 2 Section
Second Child's Information
Child's Gender*
Child's First Name*
Child's Middle Initial
Child's Last Name*
*Child's Social Security Number
Child's Date of Birth:*

MonthDayYear
Relationship to Parent*
Race*

Children who DO NOT Need Care Child 3 Section
Third Child's Information
Child's Gender*
Child's First Name*
Child's Middle Initial
Child's Last Name*
*Child's Social Security Number
Child's Date of Birth:*

MonthDayYear
Relationship to Parent*
Race*

Children who DO NOT Need Care Child 4 Section
Fourth Child's Information
Child's Gender*
Child's First Name*
Child's Middle Initial
Child's Last Name*
*Child's Social Security Number
Child's Date of Birth:*

MonthDayYear
Relationship to Parent*
Race*

Children who DO NOT Need Care Child 5 Section
Fifth Child's Information
Child's Gender*
Child's First Name*
Child's Middle Initial
Child's Last Name*
*Child's Social Security Number
Child's Date of Birth:*

MonthDayYear
Relationship to Parent*
Race*

Children who DO NOT Need Care Section Collapse Stopper
*Providing your social security number is optional.

Child Care Provider Information

If applicable, please fill out the name of your current child care provider or the name of the child care provider you plan to use.
Do you currently have a child care provider?*
Do you know the name of the child care provider you plan to use?*

Orientation to Complaint Form

NOTE: TO READ THE ENTIRE FORM, CLICK THE GRAY BAR ON THE RIGHT OF THE BOX BELOW TO SCROLL TO THE BOTTOM. YOU MUST SCROLL THROUGH TO THE END OF THE TEXT TO BE ABLE TO CLICK THE CHECK BOX.
Please do not initial below until you have read and understand the contents of this notice.
This is to certify that I have read the Orientation to Complaint Procedure and that I have been given the opportunity to ask questions about its contents. By clicking the Orientation to Complaint box below, I acknowledge this orientation to the Complaint Procedure and the statement regarding Equal Opportunity Is The Law. Contact Workforce Solutions for the Heart of Texas at 254-754-5421 if you have questions about the contents of the form.

(Detailed instructions and the appropriate address for the program in which you are enrolled is listed HERE. Las instrucciones detalladas y el direccionamiento apropiado se enumera AQUI).

Favor de no firmar sin haber leído este aviso y comprende su contenido.
Por esta, confirmo que he leído el Orientación de Dar Quejas Para Aplicantes y Participantes, y que he tenido la oportunidad de hacer preguntas acerca de su contenido. Al poner sus iniciales, declaro que he recibido esta orientación a la Póliza De Dar Quejas y que entiendo la sección titulada Igualdad De Oportunidades Es La Ley. Contacte Workforce Solutions for the Heart of Texas en 254-754-5421 si tiene preguntas sobre el contenido de la forma.
Initial Here*
Type your first, middle and last initial.
Verification of Non-Fraudulent Submission
Please use your mouse (finger for touchscreen) to sign your name below.*

Clear
Date & Time
The Texas Workforce Commission in partnership with 28 local workforce development boards forms Texas Workforce Solutions Equal Opportunity Employer/Program Auxiliary Aids and Services are available upon request to individuals with disabilities. Relay TX: 711 or 1-800-735-2988 (Voice) or 1-800-735-2989 (TDDLa Texas Workforce Commission esta en colaboración con 28 juntas locales de desarrollo laboral forman La Texas Workforce Solutions. Es un empleador que promueve la igualdad de oportunidades. Relay TX: 711 o 1-800-735-2988 (Voice) o 1-800-735-2989 (TDD). Documentos y formularios estan disponibles en Español a peticion. Favor de llamar al 1-877-223-0404 ext 4013.
Should be Empty:

Eligibility Screening

Please answer the following questions. If you meet the basic eligibility requirements, you can proceed to the full application.

It looks like you live in a county outside of the Heart of Texas service region. Only residents of Bosque, Falls, Freestone, Hill, Limestone and McLennan counties are eligible to receive Child Care Assistance from the Heart of Texas Workforce Development Board.

What You Can Do

Based on your response to this eligibility question, you don't qualify for Child Care Assistance from Workforce Solutions for the Heart of Texas. We encourage you to review our Parent Resources web page for additional resources and information that may be helpful to you.

Based on your response to this eligibility question, you don't qualify for Child Care Assistance from Workforce Solutions for the Heart of Texas. We encourage you to review our Parent Resources web page for additional resources and information that may be helpful to you.

Because you have recently applied for or are enrolled in the Choices or TANF program, you must call Bobbie Williams of Workforce Solutions at 254-296-5219 or toll free at 866-982-9226 before you can apply for Child Care assistance. Thank you.

Based on your response to this eligibility question, you don't qualify for Child Care Assistance from Workforce Solutions for the Heart of Texas. We encourage you to review our Parent Resources web page for additional resources and information that may be helpful to you.

Based on your response to this eligibility question, you don't qualify for Child Care Assistance from Workforce Solutions for the Heart of Texas. We encourage you to review our Parent Resources web page for additional resources and information that may be helpful to you.

Priority of Service

NOTE: You will be required to submit the following documents if you check the corresponding box above:

Parent Information

Parent Contact Information

Parent Employment & School Information

Employment Information

Employer 2 Information

Employer 3 Information

School Information

Household Information

Spouse/Significant Other Information

Spouse/Significant Other Contact Information

Spouse/Significant Other Employment & School Information

Employer Information

School Information

Children in Need of Care Information

Child's Information

Second Child's Information

Third Child's Information

Fourth Child's Information

Fifth Child's Name

Children Who DO NOT Need Care Information

Child's Information

Second Child's Information

Third Child's Information

Fourth Child's Information

Fifth Child's Information

Child Care Provider Information