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Child's Name: *
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Note: Each child requires his/her own application.
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Child's Birthdate: *
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(MM/DD/YYYY)
Note: Children entering the program must be at least 3 months old and not yet Kindergarten
eligible in mid-August of the year of enrollment.
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Child's Sex:
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Does your child have an Individualized Education Plan (IEP)? *
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Date you would like child to
START being considered for entry: * |
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(MM/DD/YYYY)
Note: The school year begins in August, though spaces may become available throughout
the year as vacancies occur. |
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Siblings currently enrolled in UCB ECEP: |
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Centers/Dates:
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Street Address: *
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City: *
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State: *
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Zip: *
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Country: *
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First Name: * |
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Last Name: * |
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UC Employee ID Number: (if applicable) |
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Job Title: |
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Cell Phone: *
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Work Phone: |
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Work Address: |
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Dept: |
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Email Address: *
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Re-enter Email Address: *
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First Name: |
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Last Name: |
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UC Employee ID Number: (if applicable) |
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Job Title: |
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Cell Phone: |
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Work Phone: |
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Work Address: |
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Dept: |
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Email Address: |
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Re-enter Email Address:
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Check ALL boxes that apply: * |
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Any additional notes you want to include:
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By checking the following boxes, as Parent or Legal Guardian, you agree to the application and enrollment policies:
- The child is enrolled in the program
(If you choose to leave the program and wish to re-enroll, you will need to reapply to be added back to the waiting list.)
- You ask to be removed from the waiting list
- You do not respond to 2 email contact attempts
- You decline 3 enrollment offers
All information will be kept strictly confidential by the UCB Early Childhood Education Program.
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