Contact Us

* Choose one of the following that best describes your role.

Family Child Care Provider Foster Parent State Agency Community Partner

* Parent/Guardian

Child Name

CAPS Case No. / Application No.

Application or Renewal Date (mm/dd/yyyy)

Phone¹

Email²

*^1,2 You must provide at least one method of contact.

* County

* Are you currently receiving CAPS child care benefits?

Are you the victim of domestic violence?

Are you homeless?

Are you a minor parent (age 20 or yourger)?

Is your child(ren) currenty enrolled in the Georgia Pre-K program?

* Parent/Guardian

* Child Name

CAPS Case No. / Application No.

Application or Renewal Date (mm/dd/yyyy)

Phone¹

Email²

^1,2 You must provide at least one method of contact.

* County

* Are you currently receiving CAPS child care benefits?

* Provider Name

* Your Name

Provider Maximus ID No.

License or Exemption No.

Parent/Guardian

Child Name

Scholarship Certificate No.

CAPS Case No.

Contact Phone Number¹

Email²

^1,2 You must provide at least one method of contact.

* County

* Agency Name

* Your Name

Parent/Guardian

Child Name

Child DOB (mm/dd/yyyy)

Phone¹

Email²

^1,2 You must provide at least one method of contact.

* Organization Name

* Your Name

Phone¹

Email²

^1,2 You must provide at least one method of contact.

Contact Us

This contact form will gather information from you to help CAPS answer your questions and support your needs. Review the form to make sure all required fields, designated with an asterick(*), are completed, and then click the "Submit" button. Please provide as much information as possible.

* Choose one of the following that best describes your role.

* Choose one of the following that best describes your reason for contacting us.

* Explain clearly your reason for contact with specific details. The character limit for this field is 1000 characters.

Please attach new application form. Don’t forget to sign the application.

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