CTOEC Licensing Change Form for Family Child Care Staff and Assistants

For approved family child care substitutes and assistants
Use this form if you are an approved family child care substitute or assistant and your name, home address, or email has changed.

If you are a licensed provider reporting a change to your program, use the report a change form for family child care homes instead.
Full name

First NameLast Name
Approval number
Your approval number is printed on your approval certificate next to your name.
Email where we can reach you
Phone
Format: (000) 000-0000.
What changed?

Check everything that applies.
What do you need to change?
Your new information

We only ask for what you checked above.
New full name (first and last)

First NameLast Name
After you submit this form, OEC will email you to ask for proof of your new name: a government-issued ID that shows the new name, or the court document that approved the change.
New home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Date you moved or will move

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
New email
Enter your new email again
Type the same email again.
Ready to submit?

Sign and date to send your change to OEC Licensing.
Sign here to confirm this information is correct
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty:

What changed?