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California Children Services:
CCS
This application
is to be completed by the parent, legal guardian or applicant, if
the applicant is 18 years or older. "Applicant" means the child
for whom the services are being requested. PLEASE READ ALL THE INFORMATION
ON THIS APPLICATION.
(Esta aplicacion debe ser completada por los padres, tutor o aplicante
mayor de 18 anos. "Aplicante" quiere decir que es el niņo/a por
quien servicios son necesitados. FAVOR DE LEER TODA LA INFORMACION
EN ESTA APLICACION.)
Click the following links to obtain the California Department
of Health Services's Application to Determine CCS Program Eligibility
(DHS4480):
You may download and complete
these forms on your computer. You may return them to CCS by FAX
(805 681-4763) OR by mail. Call CCS to verify the receipt of these
forms. (Usted puede descargar y llenar el formulario en su computadora.
Usted puede devolverlo a CCS por fax (805 681-4763) O por correo.
Llame a CCs para verificar el recibo de estas formas.)
Send to:
California Children Services
1111 Chapala Street, Suite 200
Santa Barbara, CA 93101
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