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CCA-1203A FORFF (3-16) ARIZONA DEPARTMENT OF ECONOMIC SECURITY Child Care Administration Date: REQUEST FOR CHILD CARE RESOURCES This form is designed to assist child care providers in requesting available resources when issues arise that may result in expulsion of a child from the child care setting. Instructions: Complete all sections of this form and forward the form to a DES Resource Specialist. The DES Resource Specialist will provide resources within one business day of receipt of this request. C h i l d
I nfo rm a t i o n fo r C h i l d
C a r e
R e s o u rces Equal Opportunity Employer/Program • Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, the Age Discrimination Act of 1975, and Title II of the Genetic Information Nondiscrimination Act (GINA) of 2008; the Department prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics and retaliation. The Department must make a reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other reasonable action that allows you to take part in and understand a program or activity, including making reasonable changes to an activity. If you believe that you will not be able to understand or take part in a program or activity because of your disability, please let us know of your disability needs in advance if at all possible. To request this document in alternative format or for further information about this policy, contact 602-542-4248; TTY/TDD Services: 7-1-1. • Free language assistance for DES services is available upon request. • Ayuda gratuita con traducciones relacionadas con los servicios del DES está disponible a solicitud del cliente. CCA-1203A (3-16) – Page 49 Arizona Department of Economic Security