Program Forms & Documents
The following items are resources for each of our programs and services. For parents and child care providers who participate in our programs, please consult with a Program Specialist about which forms are required of you. If you would like to have a document or form mailed to you, or if you have any questions about these items, please contact your local CHS office.
For Families
Click Here for Program Forms and Documents for Families
Child Care Eligibility List (CCEL)
Eligibility Questionnaire – English – Spanish – Vietnamese
Child Care Payment Program (CCPP) and Family Child Care Home Education Network (FCCHEN) – For Families
Family Participation Handbook – English – Spanish
Family Participation Handbook – Acknowledgement of Receipt – English – Spanish
Child or Spousal Support Affidavit – English – Spanish
Declaration Form – English – Spanish
Declaration (Employment) Form – English – Spanish
Declaration – (Reduction) – English – Spanish
Declaration Form (In-Home Provider) – English – Spanish
Declaration Form (Vocational Training/Educational Program) – English – Spanish
Declaration Form (Zero-Income) – English – Spanish
Domestic Services Employment Verification – English – Spanish
Educational Program Verification – English – Spanish
Employment/Income Verification – English – Spanish
Participation Requirements – At Risk – English – Spanish
Participation Requirements – Child Protective Services – English – Spanish
Participation Requirements – Educational Program – English – Spanish
Participation Requirements – Employment – English – Spanish
Participation Requirements – Homelessness – English – Spanish
Participation Requirements – Parental Incapacity – English – Spanish
Participation Requirements – Seeking Employment – English – Spanish
Participation Requirements – Seeking Permanent Housing – English – Spanish
Participation Requirements – Vocational Training – English – Spanish
Record of Income – English – Spanish
Release and Hold Harmless Agreement – English – Spanish
Statement of Homelessness Need – English – Spanish
Statement of Parental Incapacity – English – Spanish
Statement of Seeking Employment – English – Spanish
Statement of Seeking Permanent Housing – English – Spanish
Training Verification – English – Spanish
Verification of Self Employment/Independent Contractor – English – Spanish
Child Care Resource and Referral Program (R&R)
Child Care Referral Policy – English – Spanish
CHS Resource & Referral Program Brochure – English – Spanish
Choosing Child Care Brochure – English – Spanish
Complaint Policy – English – Spanish
Parental Choice Brochure – English – Spanish
Family Education Program (FEP)
Family Education Program Resource Page
Family Education Program Material Request Website
Family Education Program Material Request Form – English – Spanish
MyCareConnect
Children’s Home Society of California (CHS) is pleased to offer MyCareConnect to families participating in the Child Care Payment Program (CCPP). MyCareConnect is an internet site and mobile app that allows families to access, complete, and submit documents directly on their computer or mobile app.
To request an account for MyCareConnect, contact your assigned Program Specialist. If you already have an account for MyCareConnect, click here to log in. Click here for information regarding creating an account with MyCareConnect.
For Child Care Providers
Click Here for Program Forms and Documents for Child Care Providers
Child Care Payment Program (CCPP) and Family child care home education network – For Providers
CCPP Written Information to Providers – English – Spanish
CCPP Written Information to Providers – Acknowledgment of Receipt – English – Spanish
Child Care Resource and Referral Program (R&R)
Appeal Policy – English – Spanish
Complaint Policy – English – Spanish
Child Care Referral Policy – English – Spanish
Choosing Child Care Brochure – English – Spanish
Resource & Referral Provider Update Form – (English/Spanish/Vietnamese)
Resource & Referral Brochure – English – Spanish
Health and Safety Reimbursement Application – Bilingual
Family Education Program (FEP)
Family Education Program Resource Page
Family Education Program Material Request Website
Family Education Program Material Request Form – English – Spanish
Helpful Forms
Address Declaration – English – Spanish
Attendance Sheet – English/Spanish
Attendance Sheet – FCCHEN Program – English/Spanish
Declaration of Exemption from TrustLine Registration and Health & Safety Self-Certification – English
Direct Deposit Form – English – Spanish
Health & Safety Self-Certification CCP4 Form – English
Lost-Stolen Check Affidavit – English – Spanish
Release and Hold Harmless – English – Spanish
Trustline Application – English – Spanish
W-9 Request for Taxpayer Identification – English – Spanish
CareConnect Provider
Children’s Home Society of California (CHS) is pleased to offer CareConnect for child care providers who are participating in the Child Care Payment Program (CCPP). CareConnect is a website and mobile app that allows providers to view authorized care for their enrolled children; access, complete, and submit digital CHS Attendance Sheets to CHS electronically; download and print CHS Attendance Sheets for their enrolled children; check the status of attendance records submitted for payment; and view payment details.
You can access CareConnect in one of the following ways:
- Download the CareConnect Application on your iOS or Android device
- Go to the CareConnect website https://careconnect.carecloud.io/
For assistance with accessing your account, please contact the Provider Relations Department at your local CHS office.