Report SR Eligibility Changes

If you already receive School Readiness services and need to report a change, fill out the form below. Please note, you are required to report changes affecting your eligibility within 10 calendar days of their occurrence, including: changes in employment, school, income, marital status, pregnancy, family size/living arrangements, address, or child(ren) not attending care.

Depending on the change you report, you may still be required to come to 4C with documentation. By filling out the form below, you are notifying us of a change and a Family Support staff member will contact you within two business days with further information or instructions.

Select a county *SelectOrange County

Name *

First

Last

Last 4 digits of SSN: *

Email *

Phone

Reason/reasons for update *

• Employment
• School
• Income
• Marital status
• Pregnancy
• Family size/living arrangements
• Child(ren) not attending care
• Address
• Other

Please give a brief summery of the change you need to report: *

Please give us an estimated date when your previous employment/school/income/family size/address ended: *

Click to select date on calendar.

Please give us an estimated date when your new employment/school/income/family size/address began: *

Click to select date on calendar.

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