SSDC Child Care Scholarship Program Change of Information Form

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* 1. Parent/Guardian First & Last Name (please type):

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* 2. Name (first & last) of child/children currently on SSDC Scholarship Program (please type):

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* 3. Are you reporting a change in address?

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* 4. Are you reporting a change in telephone number?

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* 5. Are you reporting a change in household members (family size)?

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* 6. Are you reporting a change in income (job change, child support change, Social Security income change, change to any other type of earned or unearned income)?

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* 7. Will your change in income increase your household income or decrease your household income?

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* 8. If you answered "increase" above, will your household still be under the SSDC Scholarship Program income limits?  Please view program income limits here: SSDC Scholarship Program Income Limits

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* 9. If you answered "decrease" to question #7, would you like for SSDC to redetermine your income to see if your monthly parent fee can possibly be reduced? If yes, please note that you will be required to submit documentation/proof of income change.

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* 10. If you are reporting a student status change, please select the most appropriate answer below.

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* 11. If you have any other updates or changes, and feel as though the questions above do not address your change/update, please feel free to share below.

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