Non-Subsidized Child Care
Application For Child Care

(Please submit a separate application for each child)

Child
Child's First Name:
Child's Last Name:
Date Your Child Needs Care:  (mm/dd/yyyy)
Child's Gender:
Child's Date of Birth:  (mm/dd/yyyy)
 
Name(s) of your other children currently enrolled at UCSD child care:
  First Name                        Last Name
Child 1:
Child 2:
Child 3:
 
Are you a single parent?
Are you eligible for a PELL grant?
Are you interested in applying for subsidized child care?
 
Parent/Guardian 1
First Name:
Last Name:
Home Phone Number:
Work Phone Number:
Address:
City: State: Zip:
Email:
Employment Status:
UCSD Affiliation:
 
     
Subsidized Child Care
If you are interested in applying for subsidized child care, please read the qualifications below and complete this section.

Childhood Education Center offers full-time, on-campus subsidized child care through a program sponsored by the California Department of Education. To qualify for subsidy support, parents must be working or in school and also meet income eligibility guidelines. Children must be at least 11 months old and walking, and are eligible up to age 5-1/2. (The Center's kindergarten program is not subsidized.)
 
  First Name Last Name
Name(s) of child(ren) being subsidized
 
 
 
 
Name(s) of other children in the household
 
 
Name(s) of Parent(s) receiving income
 
 
List of other adults in the household
 
Total number of people in the household
 
Income Information
List specific name and amout of each source -- include loads, grants, Federal Work Study, alimony/child support, AFDC, outside jobs, etc.):
 
Employer/Income Source Amount Per Month
 
Please send in copies of proof for each source of income: check stubs, award letters, Federal Income Tax return, etc.
 

Note: Your waitlist application is not complete until your non-refundable application fee of $35 per child has been received by the administration office. Submitting this application places your child on a waiting list pending receipt of your non-refundable application fee of $35 for each child. Your child will be considered by the date of application as space becomes available. [If you meet the income guidelines for subsidized child care, you do not need to submit an application fee.] After submitting your on-line application, mail your check, payable to UC Regents, to the address below.
 
After submitting your on-line application, mail your check, payable to UC Regents, to the address below.
 
University of California
Early Childhood Education Center, MC 0962
9500 Gilman Drive
La Jolla, CA 92093-0962
 
Parents/Guardians are responsible for keeping contact information (phone number and address) current. If we cannot reach you, your child(ren) will be removed from the waiting list. To change your phone number or address, call our office at (858) 246-0900.
 
If you would like to receive an e-mail confirmation, please enter your e-mail address here:
 
 

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