Concho CC Enrollment FY2023

Welcome to Workforce Solutions of Concho Valley

Child Care Services

NEW APPLICATION

Please allow at least 30 minutes to complete the form. If you exit before pushing the ‘Submit’ button your progress will not be saved.

You will have the opportunity to upload the required documents. Please make sure you have all the required documents available to upload. If you are unable to upload the required documents, please submit them by email, fax, mail, or hand-deliver to the CCS Office.

E-mail to: childcare@cvworkforce.org

Fax: 325-655-4649

Mail: 202 Henry O. Flipper St., San Angelo, TX 76903

Hand deliver 202 Henry O. Flipper St., San Angelo, TX 76903

Child Care Services Application

To be eligible for child care services:

•             Child(ren) must be a U.S. citizen or legal immigrant.

•             Meets one of the following age requirements:

Be under 13 years of age; or

A child with disabilities under 19 years of age.

• The family must reside within the Concho Valley region. Concho Valley region includes the counties of Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan, Schleicher, Sterling, Sutton, and Tom Green.

•             The family should have a total gross income that does not exceed 85% of the State Median Income (SMI).

•             Parent(s) must be participating in training, education, or employment activities an average of 25 hours a week for a single-parent household or a combination of 50 hours for a two-parent household.

CCS may also consider:

•             Other income received in the household.

•             The family composition and benefits received.

Be prepared to submit the following items:

•             Birth Certificate or verification of birth facts for each child applying for services.

•             Proof of current residency (Example: Utility bill or lease agreement).

•             Documentation of the most recent three months of income (from employment and other sources of income) for each member of the household.

•             Current school schedule and transcripts. (If applicable)

•             Current valid picture ID from each parent/ caretaker.

•             If your child(ren) has a disability, the current disability documentation. (Examples: letter from a doctor, IFSP from an Early Childhood Program, or the IEP from the school).

•             Provide social security numbers for all household members (optional)

If you exit before clicking the ‘Submit’ button your progress will not be saved and will not be received.
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WORKFORCE SOLUTIONS OF CONCHO VALLEY BOARD ORIENTATION TO DISCRIMINATION COMPLAINT PROCEDURES FORM(29 CFR Past 38)
This Orientation to Discrimination Complaint Procedures form addresses discrimination complaint procedures for the listed programs and services administered in the workforce development area by the Workforce Development Board and its Contractors:

Workforce Innovation and Opportunity Act (WIOA)

Temporary Assistance for Needy Families (TANF) / CHOICES

Supplemental Nutrition Assistance Program Employment & Training (SNAP E&T)

Child Care Services (CCS)

Trade Adjustment Assistance (TAA) and Trade Readjustment Allowances (TRA)
THE RECIPIENT OF THE FEDERAL FINANCIAL ASSISTANCE IS:

Concho Valley Workforce Development Board Orientation to Discrimination Complaint Procedures form (29 CFR Part 38)
The recipient of federal financial assistance is:
Concho Valley Workforce Development Board
36 E. Twohig Ste 805
San Angelo, TX 76903
Equal Opportunity (EO) Officer: Sylvia Martinez
Telephone Number: 325-703-2453
Relay Texas: 1-800-735-2989/TTY 1-800-735-2988 (Voice)
The Workforce Solutions of Concho Valley Board (the Board) shall resolve equal opportunity complaints in a fair and prompt manner. Acts of restraint, interference, coercion, discrimination, or reprisal towards complainants exercising their rights to file a complaint under this procedure are prohibited. This procedure applies to all applicants and participants who have cause to file a discrimination complaint related to activities or programs administered by the Board. If you have an equal opportunity complaint concerning any of these programs, you may submit your written complaint to the Board or Contractor EO Officer, as appropriate.

After your equal opportunity complaint has been received, the EO Officer will notify you of the next step in the complaint process. As long as you wish to pursue your complaint, the Board or Contractor will follow the steps described below. You should study the Discrimination Complaint Procedure carefully, and if you feel that the required steps are not being followed, contact the EO Officer. Remember, if you feel you are not being provided enough help at any stage of the complaint process, you should contact:
Texas Workforce Commission (TWC)

Equal Opportunity Monitoring

101 E. 15th St. Room 242-T

Austin, TX 78778-001

Telephone Numbers:

(512) 463-2400

Relay Texas: 1-800-735-2989

TTY 1-800-735-2988 (Voice)
EQUAL OPPORTUNITY IS THE LAW

It is against the law for this recipient of Federal financial assistance to discriminate on the following bases: against any individual in the United States, on the basis of race, color, religion, sex, national origin, age, disability, political affiliation, or belief; and against any beneficiary of programs financially assisted under Title I of the Workforce Innovation and Opportunity Act (WIOA), on the basis of the beneficiary’s citizenship/status as a lawfully admitted immigrant authorized to work in the United States, or his or her participation in any WIOA Title I-financially assisted program or activity. The recipient must not discriminate in any of the following areas: deciding who will be admitted, or have access, to any WIOA Title I-financially assisted program or activity; providing opportunities in, or treating any person with regard to, such a program or activity; or making employment decisions in the administration of, or in connection with, such a program or activity.

What to do if you believe you have experienced discrimination. If you think that you have been subjected to discrimination under a WIOA Title I-financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with either: the recipient’s Equal Opportunity Officer (or the person whom the recipient has designated for this purpose); or the Director, Civil Rights Center (CRC), U.S. Department of Labor, 200 Constitution Avenue NW, Room N-4123, Washington, DC 20210. If you file your complaint with the recipient, you must wait either until the recipient issues a written Notice of Final Action or until 90 days have passed (whichever is sooner), before filing with the Civil Rights Center (see address above). If the recipient does not give you a written Notice of Final Action within 90 days of the day on which you filed your complaint, you do not have to wait for the recipient to issue that Notice before filing a complaint with CRC. However, you must file your CRC complaint within 30 days of the 90-day deadline (in other words, within 120 days after the day on which you filed your complaint with the recipient). If the recipient does give you a written Notice of Final Action on your complaint, but you are dissatisfied with the decision or resolution, you may file a complaint with CRC. You must file your CRC complaint within 30 days of the date on which you received the Notice of Final Action.
PROCEDURES ON HOW TO FILE A COMPLAINT

WORKFORCE INNOVATION AND OPPORTUNITY ACT (WIOA) / TRADE ADJUSTMENT ASSISTANCE (TAA) and TRADE READJUSTMENT ALLOWANCES (TRA):

If you think you have been subjected to equal opportunity discrimination under a WIOA Title I or a TAA/TRA financially assisted program or activity, you may file a discrimination complaint within 180 days from the date of the alleged violation with either the Board/Contractor Equal Opportunity Officer (or designee) or Director, Civil Rights Center (CRC), U.S. Dept. of Labor, 200 Constitution Avenue NW, Room N-4123 Washington, DC 20210. If you file your complaint with the Board or Contractor, you must wait until you receive a written Notice of Final Action or 90 days have passed (whichever is sooner) before you can file with the CRC. If the written Notice of Final Action is not issued within 90 days of the day you filed your complaint, you have 30 days following the 90-day deadline to file a complaint with CRC (that is, within 120 days of the day you first filed your complaint). If you receive a written Notice of Final Action on your complaint but are dissatisfied with the decision, you may file a complaint with CRC. However, you must file your CRC complaint within 30 days of receiving the Notice of Final Action.

TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF) / CHOICES and/or CHILD CARE SERVICES (CC):

If you think you have been subjected to equal opportunity discrimination under a TANF/Choices and/or Child Care (CC) program or activity receiving federal financial assistance, you may file a complaint within 180 days from the date of the alleged violation with either the Board/Contractor Equal Opportunity Officer (or designee) or U.S Department of Health and Human Services (HHS), the Office for Civil Rights, 1301 Young Street, Suite 1169, Dallas, TX 75202, (800) 368-1019. Those filing complaints against child care program services receiving USDA federal financial assistance may choose to contact the U.S. Department of Agriculture (USDA), Office of Adjudication, 1400 Independence Avenue, SW, Washington, D.C. 20250-9410. If you file your complaint with the Board or Contractor, you must wait until a written Notice of Final Action is issued or until 90 days have passed (whichever is sooner) before you can file with the U.S. Department of Health and Human Services.

SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM EMPLOYMENT AND TRAINING (SNAP E&T):

If you think you have been subjected to discrimination under a SNAP E&T financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with either the Board/Contractor Equal Opportunity Officer (or designee) or the U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, SW, Washington, DC 20250-9410, (202) 260-1026. If you file your complaint with the Board or Contractor, you must wait either until a written Notice of Final Action is issued or until 90 days have passed (whichever is sooner) before filing with the U.S. Department of Agriculture.

ADULT EDUCATION AND LITERACY:

If you think you have been subjected to discrimination under an Adult Education and Literacy financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with either the Board/Contractor Equal Opportunity Officer (or designee) or the US Department of Education. If you file your complaint with the Board or Contractor, you must wait either until a written Notice of Final Action is issued or until 90 days have passed (whichever is sooner) before filing with the US Department of Education, 400 Maryland Ave SW, LBJ Room 2E-349, Washington, DC 20202-4537.

Please do not sign this notice until you have read it and understand its contents.

By my signature below, I acknowledge this orientation to the discrimination complaint procedure and the statement regarding Equal Opportunity Is the Law. I affirm that I have read the Orientation to Discrimination Complaint Procedures Form and that I have been given the opportunity to ask questions about its contents. I understand that the One-Stop application form is not a job application; rather, this form is used to determine my eligibility to receive program services and to meet federal reporting requirements. I further understand that failure to provide the requested information may prevent me from receiving services.
Name*

First NameLast Name
Applicant Signature*

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Document Checklist for Child Care Eligibility

YOU WILL NEED TO PROVIDE THE FOLLOWING DOCUMENTS TO CHILD CARE SERVICES WITHIN 5 BUSINESS DAYS.
Identification Information - for all adults in household*
Identification Information - for all adults in household upload*

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Documentation for Age & Citizenship - all children in household: (one of the following for each child)*
Documentation for Age & citizenship *

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Employment income: (For all household members who are working)*
Please click on the link to print and fill out the Employment Verification Form.

Employer Wage and Work Schedule Verification
Link to Child Care Services Employment/Income Verification
Employment income (please upload files as needed).

Browse Files

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Other Income*
Other income

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Education:(For all parents who are pursuing a college degree).*
Education (Please, upload files as needed).

Browse Files

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Education:(For all parents who are pursuing GED or high school equivalency)*
Education: GED

Browse Files

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Proof of Residency*
Proof of Residency:*

Browse Files

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Release of Information

Form must be signed and dated by all parent(s)/guardian(s)
Please read carefully the information contained in this form. When you have finished, please initial in the spaces provided. Once you have signed and dated it, please return the original to CCS at the address provided.

I hereby authorize Workforce Solutions of Concho Valley Child Care Services (CCS) to conduct such inquiries as may be deemed necessary to:
- Verify eligibility for all Child Care programs administered by the WSST or its representatives
- Confirm any information on the application used to determine eligibility
- Secure appropriate services for me from community resources
- Release any information requested to officially recognized organizations
- Determine the effectiveness of this program in assisting participants in achieving sufficiency
I hereby authorize the Texas Workforce Commission, or any private sector service provider maintaining such records, to release to the WSST any information with regard to my entitlement to benefits or program effectiveness.

I expressly agree to waive liability for any effect the information received from contacted sources, given by myself, or released to outside sources of my produce.

WSST will maintain the confidentiality of any such information received.
Parent Agreement to Report Child Care Attendance

As a requirement for my child to receive child care services, I understand and agree to the following attendance standards:
• I will ensure that my child attends child care on a regular basis.
• I understand that failure to meet attendance standards may result in termination of child care services;
• I understand that if a child exceeds 40 total absences during their current 12-month eligibility period, then the child can be terminated from care for unexplained excessive absences.

• I understand that failure to meet the provider’s established policy regarding attendance may result in the provider ending the child’s enrollment at the facility.

• I understand that absences due to a child’s documented chronic illness, disability, or court-ordered visitation are not counted in the number of absences allowed.
Signature

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PARENT RIGHTS

·        You have the right to:

·        Be informed of all child care options available to you and choose the type of child care provider (licensed center, licensed home, registered home, relative care) that best suits your needs

·        Visit available child care providers before making a choice

·        Receive assistance in choosing child care, including information about the Local Workforce Development Board’s (Board) policies regarding transferring children from one provider to another

·        Be informed of rules related to providers charging parents the difference between the Board’s reimbursement and the provider’s published rate

·        Be represented when applying for child care services

·        Be notified of your eligibility to receive child care services within 20 calendar days from the day the Board’s child care contractor receives all necessary documentation required to initially determine or redetermine eligibility for childcare

·        Have the Board and the Board’s child care contractor treat information used to determine eligibility for child care services as confidential

·        Receive written notification at least 15 calendar days before termination of child care services

·        Reject an offer of child care services or voluntarily withdraw your child from child care, unless the child is in protective services, and be informed of the possible consequences of rejecting or ending the child care that is offered

·        Be informed of eligibility documentation and reporting requirements

·        Be informed of your right to appeal, including the right to continue care during the appeal and the potential for repayment if the appeal is rendered against you

·        Receive child care services regardless of race, color, national origin, age, sex, disability, political beliefs, or religion

Be informed of the process to file a written complaint of alleged discriminatory acts within 180 calendar days from the date of the alleged discriminatory act

PARENT RESPONSIBILITIES

• Must be working, training, or attending school for at least 25 hrs. per week
• Must reside within Webb, Jim Hogg, or Zapata Counties
• Child(ren) must be under 13 years of age or under 19 years of age if my child has a disability to receive child care services
• must be within the income guidelines
• must provide and sign all required documentation prior to authorization of child care services
• must notify CCS of any changes that affect your eligibility within 14 business days after the day of occurrence
 changes of income or family size that result in household income being over 85% SMI
 Permanent loss of employment, training or education program participation (voluntary or involuntary)
 Changes in the contact information
• Must pay parent fee in advance, before receiving child care
• Parent share of cost must be paid even when a child(ren) is absent
• Must pay any other child care subsidy I might receive from another agency to the child care facility
• Meet the enrollment requirements of the child care facility
• Notify my child care provider when my child(ren) will be absent and tell the reason for the absence
• Must not exceed 40 absences in a 12month period
• Must provide information including healthy, immunization records, authorization to secure medical assistance and parent contact information to be used in case of an emergency
• Will be on time to and honor the child care facilities starting and closing hours
• Will pay any additional charges incurred if I am late to pick up my child (ren)
• Will report any possible violation of licensing standards within the child care facility
• I will make other child care arrangements on any of the provider’s nine paid holidays. This will be private pay.
• I will make other childcare arrangements when I am no longer eligible for childcare services

By signing this form I certify that I have been made aware of my rights and responsibilities and have been given a copy of them.
Agree to receive text message and understand that standard text messaging rates and fee from my mobile carrier may apply.
Signature of Applicant (Parent/Guardian #1)*

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Printed Name*

First NameLast Name
Date Signed

MonthDayYear
Date
Signature of Applicant (Parent/Guardian #2)

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Printed Name

First NameLast Name
Date

MonthDayYear
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Signature of Parent/Guardian if Applicant is a Minor

Clear
Printed Name

First NameLast Name
Date

MonthDayYear
Date
The Texas Workforce Commission prosecute fraud to ensure that child care funds are maximized for qualified families. To report suspected fraud, call the fraud hotline as (800) 252-3642
Should be Empty:

	Current	Last Six Months	Never
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	Current	Last Six Months	Never
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	Current	Last Six Months	Never
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	Current	Last Six Months	Never
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	Current	Last Six Months	Never
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WORKFORCE SOLUTIONS OF CONCHO VALLEY BOARD ORIENTATION TO DISCRIMINATION COMPLAINT PROCEDURES FORM(29 CFR Past 38)

Section 1 Applicant Information

Federal Reporting Data

Contacts

SECTION II - WORK, EDUCATION, AND TRAINING

School and Training of Household Members

SECTION III - FAMILY INFORMATION

SECTION IV - LANGUAGE LINE NOTICE

Release of Information