Based on your responses, you may be eligible for Workforce Solutions Child Care Services. Please complete the entire application below and submit it. An email will be sent to you confirming that your application was received.


STEP 1 of 2: CHILD CARE WAITLIST APPLICATION

PRIORITY OF SERVICE INFORMATION

Welcome! Certain groups may qualify for priority of service.
Please answer the following questions to see if you qualify.


If you answer "Yes" to any of the below questions, you may receive child care sooner. A description of the documentation required to prove priority is also listed.

Are you a qualified veteran?
(You will need to provide a DD214 or self-attestation form)
Are you a spouse of a qualified veteran?
(You will need to provide a DD214 document or Veteran Self-Attestation form)
Are you a current or former foster youth between the ages of 14-23?
(You will need to provide a letter from the Texas Department of Protective and Regulatory Services)
Are you a teen parent (age 19 and younger)?
(Your school counselor must complete a Verification of School Enrollment Form)
Are you a parent of a child with a disability who needs child care?
(You will need to provide medical documentation)
Are you currently receiving child care assistance from a different area of Texas?
(You will need to provide Forms 2450 and 2050 from the current child care program)
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.
APPLICANT INFORMATION
Title: Miss  Ms.  Mrs.  Mr. 
First Name:
Middle Initial:
Last Name:
SSN*:
Gender: Male  Female
Date of birth:
Marital Status:
Race:
Ethnicity: Hispanic or Latino? Yes No
Physical Address:
Apartment #:
City:
State:  Zip Code:
My mailing address is the same as my physical address: Yes No
Mailing Address:
Apartment #: 
City:
State:  Zip Code: 
County:
Main Phone Number:
Alternate Phone Number:
Email Address:
   
Employment Information (if applicable)
Are you currently employed? Yes No
School Information (if applicable)
Are you currently enrolled in school? Yes No
SPOUSE OR SIGNIFICANT OTHER INFORMATION (IF APPLICABLE)
Do you have a Spouse or significant other? Yes No
DO YOU OR YOUR SPOUSE/SIGNIFICANT OTHER
RECEIVE ANY OF THE FOLLOWING?
Food Stamps: Yes   No
Workforce Innovation and Opportunity Act (WIOA): Yes   No
Transitional: Yes   No
TOTAL NUMBER OF PERSONS IN THE HOUSEHOLD
What is the total number of persons living in the household (this includes parent/caretaker, spouse or significant other, all children, and any other dependent persons)?
INFORMATION REGARDING EACH CHILD NEEDING CARE
First Name: Middle Initial:
Last Name:
SSN*:
Gender: Male Female
Date of birth:
Relationship to Parent/Caregiver:
Age:
Race:
Ethnicity: Hispanic or Latino? Yes No
Does the child have a disability? Yes No
If yes, please explain:
Has the child ever received ECI services or been in a Special Education Program? Yes No
Type of care needed:
Add Another Child
LIST ALL YOUR OTHER CHILDREN IN THE HOUSEHOLD WHO DO NOT NEED CHILD CARE
Child's NameAge SSN* Date of Birth Gender Race Relationship

Add Another Child

CHILD CARE FACILITY INFORMATION
If you already have a child care provider or know the provider you plan to use, please tell us their name and phone number.
Child care telephone:
To search for child care, please visit the Search Texas Child Care website or the Child One Map.

*SSN information is voluntary

ORIENTATION TO COMPLAINT FORM

This Orientation to Discrimination Complaint Form addresses procedures for the listed programs and services administered in the local workforce development area by the Heart of Texas Workforce Development Board, Inc. and its Contractors:

Workforce Innovation and Opportunity Act (WIOA)
Temporary Assistance for Needy Families (TANF)/CHOICES
SNAP E&T
Child Care Services (CCS)
Employment Services
Trade Adjustment and Trade Readjustment Allowances (TAA and TRA)

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

The recipient of financial assistance is:
Heart of Texas Workforce Development Board, Inc.
801 Washington Avenue, Suite 700, Waco, Texas 76701
Equal Opportunity (EO) Officer: Aquanetta Brobston
Telephone Number: 254-296-5300
Relay Texas: 1-800-735-2989 / TTY 1-800-735-2988 (voice)

The Heart of Texas Workforce Development Board, Inc. (the Board) shall resolve 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 is prohibited.  This procedure applies to all customers, applicants, and participants who have cause to file a complaint related to activities or programs administered by the Board. 

All attempts will be made to resolve complaints on a non-discriminatory nature at the local Heart of Texas Workforce Solutions Center.  If you have received rude treatment, feel that you were given incorrect information about the programs and/or services provided at any Heart of Texas Workforce Solutions Center, have allegations of non-compliance with employment services regulations, or have other employment service related allegations of violations of employment laws, please contact the on-site Workforce Solutions Center Manager.  If you are not satisfied or cannot reach resolution and still wish to file a complaint concerning any of these programs, you may submit your written complaint to the Board’s EO Officer.

After your written complaint has been received, the EO Officer will notify you of the next step in the complaint procedure.  As long as you wish to pursue your complaint, the Board or Contractor will follow the steps described in the Complaint Procedure.  You should study the Complaint procedure carefully, and if you feel that the steps required by the Complaint Procedure are not being followed, contact the EO Officer.  Remember that at any stage of the Complaint Procedure you feel that you are not being provided enough help, you should contact:

Texas Workforce Commission (TWC) Equal Opportunity Monitoring
101 E. 15th Street, Room 242-T, Austin, TX 78778-0001
Telephone: 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 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 Investment Act of 1998 (WIA), 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 WIA 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 WIA 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 WIA Title I-financially assisted program or activity, you may file a complaint within 180 days from the date of the alleged violation with the recipient (Heart of Texas Equal Opportunity Officer), or with: The Director, Civil Rights Center (CRC), U.S. Dept. of Labor, 200 Constitution Avenue NW, Room N4123, Washington, D.C.  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.  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.

IGUALDAD DE OPORTUNIDADES ES LA LEY
La Ley require igualdad de oportunidades:  El destinatario de asistencia financiera del Gobierno Federal tiene prohibido por ley discriminar, con base en los conceptos a continuación: discriminar a cualquier persona en los Estados Unidos por motivos de su raza, color, religión, sexo, origen nacional, edad, incapacitación, filiación o ideología política; discriminar a cualquier beneficiario de programas que cuenten con apoyo financiero a tenor del Título I de la Ley de Inversión en la Fuerza Laboral (Workforce Investment Act o WIA) de 1998, por motivo de la ciudadanía o calidad migratoria del beneficiario en tanto inmigrante legalmente autorizado para trabajar en los Estado Unidos; o por motivo de su participación en cualquier programa o actividad que cuente con apoyo financiero a tenor del Título I de la WIA.  El destinatario de tal asistencia no debe discriminar en ninguno de los conceptos a continuación: en decidir quiénes han de ser admitidos o tener acceso a cualquier programa o actividad que cuente con apoyo financiero a tenor del Título I de la WIA; en la provision de oportunidades en tal programa o actividad y en el trato a cualquier personal con respecto al programa o actividad; o en la toma de decisions de empleo en la administración de tal programa or actividad o con respecto a lo mismo.

Qué hacer si usted cree haber sido discriminado/a:  Si cree haber surfido discriminación en un programa o actividad con apoyo financiado a tenor del Título I de la WIA, puede presentar una queja, dentro de los 180 días subsiguientes a la fecha de la supesta infracción, con el Oficial de Igualdad de Oportunidades del destinatario de aistencia federal (o la persona designada por el destinatario para ese efecto), o bien, con el: Director del Centro de Derechos Civiles (CRC), Civil Rights Center (CRC), Dept. Federal Del Trabajo (U.S. Dept. of Labor), 200 Constitution Avenue NW, Room N4123, Washington, D.C.  20210.  Si presenta su queja con el destinatario de asistencia federal, tendrá que esperar a que éste le expida un Aviso de Acción Definitiva por escrito, o hasta transcurridos 90 días (en la más temprana de las dos fechas) antes de presentar su queja al Centro de Derechos Civiles).  Si el destinatario de asistencia federal no le entrega un Aviso de Acción Definitiva por escrito dentro de los 90 días de la fecha de presentación de su queja, usted no tiene obligación de esperar a que el destinatario le expida dicho Avison para presentar una queja con el CRC.  Por orta parte, la queja con el CRC debe presentarse dentro de los 30 días del vencimiento del plazo de 90 días, es decir, dentro de 120 días a partir de la fecha en que presentó su queja con el destinatario.  Si éste le entrega un Aviso de Acción Definitiva por escrito con respecto a su queja y usted sigue inconforme con la decisión o resolución, puede presentar una queja con el CRC.  Hay que presentarla dentro de lost 30 días subsuguientes a la fecha en que recibió ell Aviso de Acción Definitiva.

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 initialing 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.

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.

Initials here:

VERIFICATION OF NON-FRAUDULENT SUBMISSION

I understand that if I knowingly provide false information or fail to disclose a material fact to make myself appear eligible for child care services, I may have to repay the child care program for services received fraudulently, and criminal charges may be filed against me with the local prosecuting authority.

By signing this form, I understand that: (1) a person who obtains or attempts to obtain, by fraudulent means, services to which the person is not entitled may be prosecuted under applicable state and federal laws, (2) I am applying for services from Workforce Solutions for the Heart of Texas and all information on this application represents a complete and accurate statement of my work, education or training hours, household income, and family size at the time of submission.

Type your full name into the field below. This will be treated the same as an original signature.

Please review all information before clicking Submit