Fillable Application Childcare 3 2011 Childcare Application

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Application Childcare 3 2011 Childcare Application

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1
FRESNO STATE PROGRAMS FOR CHILDREN, INC.
APPLICATION FOR SERVICES INFORMATION
Dear Parent:
Thank you for your application to Fresno State Programs for Children, Inc. We appreciate your
interest in our centers – The Joyce M. Huggins Early Education Center and the Campus Children’s
Centers. Our centers provide early education and child development services.
Please note the following:
- Your application will be placed on the waiting list for one academic year,
effective April 1 to March 30.
- If you want services for the next academic year, you MUST renew your application in
person during the month of March.
- If you do not update/renew by March 31
st
your application is placed in an inactive file and
you will no longer be on the waiting list.
- You will be contacted once we have an opening for your child.
ELIGIBILITY
Fresno State Programs for Children, Inc. provides services to the children of the California State
University, Fresno student body and to a limited extent, faculty, staff, and the larger community.
We are a funded program of the California Department of Education (CDE). We are mandated by
CDE to follow state admission priorities. Fees for low-income families are determined on a sliding
scale based on family size and income. The scale is provided by the State Department of
Education. Families paying full fee are enrolled if space is available (see “Enrollment Priority” on
page 2).
PROGRAMS
INFANT/TODDLER: The Infant/Toddler Program is available for children between 3 months
(3 MOS-2 YRS) and 2 years of age. The hours are from 7:30 a.m. to 5:30 p.m. Monday
thru Thursday and 7:30 a.m. to 3:30 p.m. on Friday.
PRESCHOOL: The Preschool Program is available for children between 3 and 6 years
(3 YRS-6YRS) of age. This program is available from 7:30 a.m. to 5:30 p.m.
Monday thru Thursday and 7:30 a.m. to 3:30 p.m. on Friday.
SCHOOL AGE: The School-Age Program is available for kindergarten children during the
(5 YRS-12 YRS) academic year. Children attending kindergarten combine with the preschool
classroom. The program is available 7:30 a.m. to 6:00 p.m. Monday thru
Friday. During the summer months the program is available for children
between the ages of 5 and 12 from 7:00 a.m. to 5:30 p.m. Monday thru
Thursday and 7:00 a.m. to 3:30 p.m. on Friday.
2
ENROLLMENT PRIORITY
It is our goal to serve as many California State University, Fresno student families as possible while
providing high quality care and education services for children enrolled in the program.
Enrollment priorities are determined by a waiting list. Individual families may apply for services at
any time during the year, but must renew their application each March. Applications that are not
renewed for the upcoming academic year are placed in an inactive file and taken off the waiting list.
Applications are considered in the following order dependent upon eligibility:
1. Currently enrolled returning families and siblings, if eligible.
2. New applications from families who are eligible for subsidized services in order of
the highest ranking using ranking criteria established by the State Department of
Education.
After enrollment of all eligible student families (both returning and new) consideration is next given
to:
3. Student families receiving subsidies from other sources (e.g. Supportive Services,
PACE, Fresno County, DSS).
4. Student families willing and able to pay the full fee.
After student families have been enrolled, consideration is then given to:
5. California State University, Fresno faculty and staff.
6. Community members.
NOTIFICATION
When a position becomes available, you are notified by telephone. You are required to provide
requested documentation regarding your financial and educational needs. If you have any
questions please call 278-0225 Monday through Friday between 8:00 a.m. and 3:00 p.m.
3
FRESNO STATE PROGRAMS FOR CHILDREN, INC.
APPLICATION FOR SERVICES
Date of Application/Renewal Date
__________________________
Child’s
Name: _____________________________________________________________________________________
Last First Middle
Child’s Birthdate: _______________________
Month Day Year
Child’s Sex: M ____ F _____
Total number in family: _______
(include self, other parent if in home, child, & siblings)
Parent A: _________________________________________________________________________
Last First Middle
Parent A Status: Fresno State Student______ Faculty/Staff________ Community________ working_______
Address Street Apartment #
City State Zip Code
Telephone: Home ________________________ Work _________________________
Message Phone (do not leave blank) ______________________
Enrolling Parent’s e-mail address_____________________________________________________
Parent B: _________________________________________________________________________
(If in same household)Last First Middle
Parent B Status: Fresno State student______ Faculty/Staff_______ Community________ working________
Semester and year you are requesting care ______________________
Have you ever applied for this child before? ___________ If yes, what date? _____________
Center Preference: _____ No Preference _____ Campus Children’s Center
_____ Early Education Center
If NOT applying for subsidized services, skip to signature section.
List all other children and adults (18 and older) living in the household who are related to your children by blood,
marriage, or adoption, that are included in the family size.
Name____________________________________ Relationship to Child________________________
Name____________________________________ Relationship to Child________________________
Name____________________________________ Relationship to Child________________________
Name____________________________________ Relationship to Child________________________
4
MONTHLY INCOME DECLARATION (SUBSIDIZED SERVICES ONLY)
List gross monthly income from all sources:
Parent A Parent B
1. Wages/Salary _______________ ________________
2. Gov’t Cash Assistance/ _______________ ________________
CalWorks
3. Child Support _______________ ________________
4. Spousal Support _______________ ________________
5. Disability _______________ ________________
6. Tips/Bonuses, other _______________ ________________
Parent Monthly Income _______________ ________________
Total Monthly Family Income _________________________
School Financial Aid _______________ ________________
SIGNATURE SECTION
I understand that it is my responsibility to provide all required documentation and to update any information on this
application that may change. I understand that if the information submitted on this application changes my eligibility
status may also change.
I declare under penalty of perjury that the above information is true and correct to the best of my knowledge.
__________________________________________________ _____________________
Parent A Signature Date
__________________________________________________ _____________________
Parent B Signature Date
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Application Childcare 3 2011 Childcare Application

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Completed 10 March 2020

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