CCS Form Logo How can I find out if I'm eligible?
Complete the e-Form below to submit a request for eligibility screening or call (325) 653-2321		  
 
Your request will not be processed unless you reside in one of the following counties that we serve:

Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan, Schleicher, Sterling, Sutton, Tom Green.
 
  *Fields in red are required  

First Name:

    
Last Name:    

Phone:

    

Address:

    

City:

    

State:

    

ZIP:

    

Email address:

    

Description of employment and/or education activity:

    

List the days and number of hours spent in work and/or education activity:

    
Gross monthly income:    

Would you like us to contact you by:

 E-mail    U.S. Postal mail   Phone  

Contact phone number:

  
     
   
 
Your request will not be processed unless you reside in one of the following counties that we serve:

Coke, Concho, Crockett, Irion, Kimble, Mason, McCulloch, Menard, Reagan, Schleicher, Sterling, Sutton, Tom Green.
 
     
  Workforce Solutions of the Concho Valley and the Concho Valley Workforce Development Board are an equal opportunity employer/program.  Auxiliary aids and services are available upon request to individuals with disabilities.

Relay Texas 800-735-2989 or 800-739-2988 voice.