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Welcome to the Wait List Application! If you think you are eligible for Child Care Services (CCS) simply fill in the application below and mail to our office: CCR&R 1600 Brown Street El Paso, TX 79902 Your application will be reviewed by our Wait List staff within five business days of receipt. If you qualify, your children who need child care will be placed on the Wait List. A letter will be mailed confirming your wait list status. If your children are placed on the Wait List you will need to update your wait list status every 180 days. If you fail to update your wait list status within the 180 days your name will be dropped from the Wait List system. You may update your status through the website, by calling, or visiting our office. Please note, your application must be complete for consideration:

Parent
Last Name: Social Security No.: Ethnicity: Home/Cell Phone: Physical Address: City: Mailing Address (if Different): City: State: Alabama Zip Code: State: Alabama Zip Code: Marital Status: Number in Household: First Name: Date of Birth (mm/dd/yyyy): Middle Initial:

Employment
Place of Employment: Address: Work Phone No: Hourly wages: How many hours a week?

College or University Degree Plan: Name of College: Number of Semester Credits Currently Enrolled:

Training- Vocational Vocational Training: Name of Training School: Address: Hours attending per week:

Spouse
Spouses Last Name: Social Security No.: Ethnicity: First Name: Date of Birth (mm/dd/yyyy): Middle Initial:

Employment
Place of Employment: Address: Work Phone No: Hourly wages: How many hours a week?

College or University
Degree Plan: Name of College: Number of Semester Credits Currently Enrolled: :

Training- Vocational
Vocational Training: Name of Training School: Address: Hours attending per week:

Does your household receive any of the following: Food Stamps: Y Child Support: Y N N TANF Benefits: Y N

Monthly Amount: $

What other type of income do you receive? (Example: Social Security, Unemployment, etc) Please specify:

Monthly Amount: $

Children
Child 1 Last Name: Social Security No.: Child 2 Last Name: Social Security No.: Child 3 Last Name: Social Security No.: Child 4 Last Name: Social Security No.: Child 5 Last Name: Social Security No.: Child 6 Last Name: Social Security No.:

First Name: Date of Birth (mm/dd/yyyy):

Middle Initial:

Sex: M

First Name: Date of Birth (mm/dd/yyyy):

Middle Initial:

Sex: M

First Name: Date of Birth (mm/dd/yyyy):

Middle Initial:

Sex: M

First Name: Date of Birth (mm/dd/yyyy):

Middle Initial:

Sex: M

First Name: Date of Birth (mm/dd/yyyy):

Middle Initial:

Sex: M

First Name: Date of Birth (mm/dd/yyyy):

Middle Initial:

Sex: M