FULL DAY KINDERGARTEN

APPLICATION

(Child must be 5 years old by September 30th)

NOTE: You are expected to update application as information provided by you changes.

Date of Application ______Requested Admission Date ______

Anticipated Duration of Enrollment ______

Child's Name ______

Gender: Female __ Male __ Birthdate _____/_____/_____ Present Age______

Parent/Guardian Name(s) ______

Home Address: ______

Number Street Apt. No.

______

City State Zip

Mother's Father's

Phone: Home ______Work #______Work #______

Email address: ______Other contact #:______

KSU AFFILIATION – affiliation will be verified using the online KSU phone directory and student information system. If not listed, please submit appropriate documentation verifying status with this application.

Circle one / KSU
Department / Circle PT or FT / Check here if not KSU Affiliated
Mother / Undergraduate student Graduate student Faculty Staff Alumni / Part time
OR
Full time
Father / Undergraduate student Graduate student Faculty Staff Alumni / Part time
OR
Full time

Previous preschool experience ______

Sibling(s) attended/attending CDC and dates of attendance

______

______

Any special needs of child (physical health or development)______

If yes, does your child have a current IFSP/IEP? Yes___ No___

Please indicate your payment method:

_____ pay out of pocket _____ KSU payroll deduction ______subsidized through county

(only surround care eligible)

The kindergarten program is from 9:00 A.M. to 3:00 P.M. If you need surround care either before and/or after kindergarten (7:00-9:00 A.M. and/or 3:00-5:30 P.M.), please indicate the needed times in the space below:

___ Kindergarten (9:00 A.M.-3:00 P.M.) only.

____ Kindergarten with Surround Care (see Fee Schedule for these additional charges)

Arrival Time: ______Departure Time:______

______

OPTIONAL: The Child Development Center encourages applications from members of protected groups. The following information is valuable in ensuring a diverse population of children.

___ African American, non-Hispanic ___ Asian or Pacific Islander ___ Hispanic

___ Native American or Alaskan Native ___ White, non-Hispanic ___ Disabled

______

FOR OFFICE USE ONLY: Date Received ______Acknowledgement Sent ______Acceptance Sent ______

PLEASE RETURN THIS FORM TO:

Kent State University Child Development Center, Attn: Pam Hutchins, PO Box 5190, Kent OH 44242-001

KINDERGARTEN ADMISSIONS POLICIES

Admission policies and procedures are administered by a committee of the CDC Advisory Board. To further the mission of the CDC as a professional development school and child development laboratory, it is necessary that each classroom reflect the diversity found in American society. Children with identified disabilities are given priority in enrollment. Other factors include full time current university affiliation, part time current university affiliation, total years the family has been at the Center, and date of application. Any child admitted to the kindergarten whose parents subsequently elect for one more year of preschool will be admitted first the following year.