Scholarship--Change of Information Form SSDC Child Care Scholarship Program Change of Information Form Question Title * 1. Parent/Guardian First & Last Name (please type): Question Title * 2. Name (first & last) of child/children currently on SSDC Scholarship Program (please type): Question Title * 3. Are you reporting a change in address? No Yes (please type new address in box below). New address: Question Title * 4. Are you reporting a change in telephone number? No Yes If Yes, please type new telephone number below. Question Title * 5. Are you reporting a change in household members (family size)? No Yes If Yes, please provide details of the change in household members. Please include full names, birth dates, relationship to child/children on Scholarship Program, etc. Question Title * 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)? No Yes (see box below) If Yes, please provide (type below) details of the income change you are reporting. Question Title * 7. Will your change in income increase your household income or decrease your household income? Increase in household income Decrease in household income Unsure Note: If unsure, please submit proof of income change to SSDC. N/A (question doesn't apply to you) Question Title * 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 Yes No N/A (question doesn't apply to you) Question Title * 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. Yes No N/A (question doesn't apply to you) Question Title * 10. If you are reporting a student status change, please select the most appropriate answer below. I have recently graduated. I have unenrolled from school and am working at least 20 hours per week. I am not currently taking any courses and am not employed. N/A (question doesn't apply to you) Question Title * 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. Question Title * 12. By typing your name below, you agree that the information you are stating on this form is true and correct (type first and last name below). Question Title * 13. Today's date: Date / Time Date CLICK HERE TO SUBMIT