Licensed or Registered Child Care Provider Update Request

Use this form if you are a Licensed or Registered Child Care Provider, with a current CCS agreement with Workforce Solutions, and need to report a change.

Request Date

mm/dd/yyyy

Type of Center

Operation #

Center Name

As listed on your license from DFPS

Center's Physical Address

Is Mailing Address Different?

Center's Mailing Address

Center Phone #

Center's Email Address

What do you need to update?

If reporting a closure; what is the closure date

mm/dd/yyyy

Tax Classification

Name of Person Reporting Change

Title of Person Reporting the Change

Phone Number of Person Reporting Change

Email of Person Reporting the Change

Term Provider Agreement

Letter requesting to termination your vendor agreement. It should include the last day you will provide services for WFS children.

File Upload

Please upload supporting documentation so we can process your change. Once your documents are uploaded, check the box under what you are uploading to validate the file was attached.

Drop your files here

Send me a copy of my responses

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