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Child Care Services Forms


After School Program Enrollment Certification CD-9608A (DOC)

Annual Summary of Eleven- and Twelve-Year-Old Children in Early Education and Support Division Child Care Programs CD-9608Bx (XLS)
Annual Summary of Eleven- and Twelve-Year-Old Children in Early Education and Support Division Child Care Programs CD-9608Bx (DOC)

Attendance and Fiscal Reporting forms are available through the Child Development Fiscal Services Web site.

Calendar Fiscal Year 2015-16 EESD-9730 (XLS)

Calendar Fiscal Year 2016-17 EESD-9730 (XLS)

Calendar Fiscal Year 2017-18 EESD-9730 (XLS)

Child Care Data Collection Privacy Notice and Consent Form CD-9600A (DOC)
Available Translations of the Child Care Data Collection Privacy Notice and Consent Form


CDD-801A and CDD-801B Child Development Data Reporting

Child Ratio Schedule CD-3705 (DOC)

Confidential Application for Child Development Services and Certification of Eligibility CD-9600 (DOC)
Available Translations of the Confidential Application for Child Development Services and Certification of Eligibility CD-9600

Desired Results Materials and Forms

Emergency and Identification Information CD-9607 (DOC)
Available Translations of the Emergency and Identification Information

Enrollment and Attendance Register CD-9400 (DOC) Requires 11 x 17 paper.

Equipment Inventory EESD-8604 (PDF) Requires Legal paper.

Equipment Purchase Approval CD-2703 (PDF)

Health and Safety Training Expenditure Report CD-5004

Income Calculation Worksheet - Cash, Wages, or Salary CD-ICW (DOC)

Notices of Action

Notification and Certification for 11 and 12-Year-Old Children CD-9608 (DOC)
Available Translations of the Notification and Certification for 11 and 12-Year-Old Children

Out of State Travel CD-2700 (DOC)

Parent Plan for Seeking Employment EESD-PPSE (PDF)

Payee Data STD-204 (PDF; 1MB)

Prekindergarten and Family Literacy Program (PKFLP) Site Change Request and Eligibility Form CD-PKFLP (DOC)

Program Narrative Change FY 2015-16 EESD-3704A (DOC)

Program Narrative Change FY 2016-17 EESD-3704A (PDF)

Program Narrative Change FY 2017-18 EESD-3704A (PDF)

Resource and Referral Program Service Data Report
The online data report (CD 2504E) completed by Resource and Referral contractors and instructions on how to obtain a contractor’s password and how to complete the data report.

Site Supervisor or Program Director Staffing Qualifications Waiver Request EESD-7701A (PDF)

Site Supervisor or Program Director Staffing Qualifications Waiver Extension Request EESD-7701B (PDF)

Statement of Incapacity CD-9606 (DOC)
Available Translations of the Statement of Incapacity

Training Verification-Parent or Caretaker Attending School or Receiving Training EESD-9605 (DOC)

Questions:   Early Education and Support Division | 916-322-6233
Last Reviewed: Monday, March 13, 2017
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