Rev. 5/21
CHILD DEVELOPMENT PROGRAM
Preliminary Application
A California State Preschool Program
PAGE 1 OF 3
Application for Spring Semester ___________ Fall Semester___________
The College of Marin Child Development Program provides part- and full-day preschool on the Kentfield campus
for the children of College of Marin students, faculty and staff. This is a preliminary application for the preschool
program, which can be submitted online, scanned and emailed, or mailed to the address on the reverse.
Eligibility
Children must be three years old by September 1st of current year to be eligible to enroll in our preschool centers
during the upcoming academic year. At least one parent must be either an employee of the College of Marin or a
College of Marin student. Community families may be eligible for full cost enrollment if space allows.
• Student parents must be enrolled in classes that lead to a vocational or educational goal and must make academic
progress every semester to continue to be eligible for child care services.
• Students enrolled in credit classes must be enrolled in at least 6 units.
• Students enrolled in noncredit ESL classes must be enrolled at least 9 hours per week.
Educational Plan
Student parents must have an Educational Plan approved by a counselor. You must bring your educational plan with you
to child care registration. Please indicate your vocational/educational goal below.
Parent Fees
Parent fees are subsidized by the California Department of Education and 10,000 Degrees and are on a sliding scale that
ranges from no cost to full cost, depending on family income and size. Priority for subsidized child care goes to the lowest
income student families.
Financial Aid
Student parents who are applying for subsidized fees and have a social security number are expected to apply for
Financial Aid. You must bring your financial aid award or denial letter with you to child care registration. All
student parents, regardless of social security status, are encouraged to seek financial assistance from the College
of Marin Foundation (check with Financial Aid for more info) and 10,000 Degrees, www.10000degrees.org,
415.459.4240.
CHILD’S NAME GENDER BIRTHDATE
PARENT 1 NAME
ADDRESS (number and street)
CITY STATE ZIP
PHONE EMAIL
OCCUPATION/EMPLOYER
EDUCATIONAL/PROFESSIONAL GOAL
COLLEGE YOU ATTEND
Indicate highest degree earned to date: High school diploma AA/AS BA MA Other
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Rev. 5/21
CHILD DEVELOPMENT PROGRAM
Preliminary Application
A California State Preschool Program
PAGE 2 OF 3
PARENT 2 NAME
ADDRESS (number and street)
CITY STATE ZIP
PHONE EMAIL
OCCUPATION/EMPLOYER
EDUCATIONAL/PROFESSIONAL GOAL
COLLEGE YOU ATTEND
Indicate highest degree earned to date: High school diploma AA/AS BA MA Other
Child lives with: Parent 1 Parent 2
Family Size (# adults and children who live in child’s household) __________
Gross Household Monthly Income (total of all sources) $__________________
Source(s) of Income Employment Self-Employment Child/spousal Support
Financial Aid CalWORKs Unemployment Other (specify) ________________
Other Children in the Household
NAME _________________________________________ AGE ______ NAME ____________________________________ AGE________
NAME _________________________________________ AGE ______ NAME ____________________________________ AGE________
NAME _________________________________________ AGE ______ NAME ____________________________________ AGE________
Primary Language spoken in the family ______________________ Other languages spoken ___________________________
Preschool Schedule (subject to change per Marin County public Health)
The College of Marin Child Study Center provides part- and full-day preschool during Fall and Spring Semesters and
follow the College of Marin Academic Calendar. The center is open Mondays through Thursdays from 7:45 am to 5:15
pm and on Fridays from 7:45 am to 4 pm. A 6-week summer session is offered based on adequate parent demand.
Indicate below the times that you will need care. This is a preliminary schedule. During registration, we will discuss your
child care needs and give you a contract with your child’s hours of attendance and child care fees, if any. Remember to
allow for class time, study time, and work time.
Mornings until 12:45 pm Full Day until 3 pm Full Day until 5:10 pm
Monday
Tuesday
Wednesday
Thursday
Friday
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Rev. 5/21
CHILD DEVELOPMENT PROGRAM
Preliminary Application
A California State Preschool Program
PAGE 3 OF 3
Health concerns, allergies, or other comments:
Please sign and submit your application via email by clicking the button below. Enrollment information will
be mailed to you. This application does not confirm eligibility or guarantee placement. Enrollment in the Child
Development Program will be determined on a space available basis, with priority given to low income student families.
Parent Signature_____________________________________________________________ Date ___________________________
For more information, please call or email:
Kahea Jackson, CDP Administrative Assistant, 415.457.8811 ext. 7468 or kjackson@marin.edu
Maureen Biggart, CDP Site Supervisor, 415.457.8811 ext. 7787 or mbiggart@marin.edu
Derry Gutierrez, CDP Site Supervisor, 415.457.8811 ext. 7784 or dgutierrez5@marin.edu
College of Marin Child Development Program
Kentfield Campus
1144 Magnolia Ave, Larkspur CA 94939
OFFICE USE ONLY
Student COM Employee Community Date Received _______________________
CalWORKs EOPS Subsidized Waiting List Full Cost Waiting List
Sent Enrollment Packet ________________________ Enrolled Where and When______________________________
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