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SCANNED COPIES OF REQUIRED DOCUMENTS ALONG WITH A COMPLETED APPLICATION
WILL BE ACCEPTED AT THIS TIME UNTIL FURTHER NOTICE.
PLEASE E-MAIL ALL DOCUMENTATION TO CDC@ELAC.EDU
Los Angeles Community College District
East Los Angeles College Campus Child Development Center
(323) 265-8788
Enrollment Application
** Please Read This Application Carefully **
The following information is provided to determine whether or not your child/children meets the entry level
requirements for this program. After reading the information, and if you believe your child/children are eligible,
complete the attached application and email scanned copies of the required documents to CDC@ELAC.EDU
I.
General Requirements for Enrollment :
●
Toddler Program: Children must be 2.0 years by June 1st of the current year.
●
Pre-school Program: Children must be 3 to 5 years of age by September 1st of
current year.
●
Kindergarten: Children must be 5 years of age by September 1st of current year.
●
Transitional Kindergarten: Children must be 5 years of age by September 2-
December 2 of the current year. *
●
Priority is given to:
1) Children of Protective Services; 2) Full-time Students for Fall/Spring (12 units) and
Winter/Summer (6 units) enrolled in of the Los Angeles Community College District; maintain a 2.0
G.P.A. 3) Faculty and Staff; 4) Community.
●
Total current household income verification will be required to determine your eligibility for the
State Preschool Program, CalWORKs and/or Center Based Programs.
●
It is recommended that children are toilet trained.
●
Children must be enrolled Monday-Friday.
●
Children should not be enrolled in another program at the same time.
●
Verification of training and/or employment is required.
II.
Requirements for Subsidized Care:
●
All general requirements in Section I.
●
The child must live in the State of California while services are being received.
●
Gross monthly income must not exceed the income ceilings established by the
State Department of Early Learning and Care Division (ELCD).
Priority is given to 4 -year-olds and then 3-year-olds.
●
III.
Requirement for CalWORKs Participants:
●
All general requirements in Section I.
●
Parent(s) must verify CalWORKs enrollment status.
Center Based Enrollment:
●
All general requirement in Section I.
●
Student parents with the highest priority will be notified, as space is available. Unsubsidized child
care fees are based on a sliding fee scale approved by the Los Angeles Community College District
Board of Trustees. The rate is between $1 - $2 an hour for students and $3 - $5 for non-students.
Note
●
*Transitional Kindergarten is the first year of a two year program, offered by the State of
California Department of Education. If your child's birthday is between September 2-December 2
of the current year, your child will be eligible to attend our program for two years.
This Institution is an Equal Opportunity Provider.
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IV.
For research purposes, we would like to know how you found out about the Child Development Center.
Please complete by marking the appropriate box in Part IV of the application.
B. Submitting An Application:
This application will only be accepted and processed when all *required documents are attached as listed below:
●
Current Verification of total household income:
1.
TANF/CalWORKs Verification, Foster Care payments or
2.
Employment Verification (2 or 4 consecutive weeks of check stubs, totaling 1 month's worth.)
3.
Unemployment and / or Disability Verification;
●
Utility Bill (gas, water, trash, electricity bill, rental agreement) as proof of physical address.
●
Family Size: Verification for all children, under the age of 18, who are part of your household is required. (i.e. birth
certificate, hospital birth record, baptismal certificate).
●
Child's Immunization: Provide current immunization record for child/children being considered for enrollment to verify
that vaccines are incompliance with Los Angeles County Dept. of Health Services Child Care Entry Guidelines.
●
Current Class Print-out, Educational Plan, and Semester Final grades: If applicable, a current enrollment verification,
educational plan, and final grades will be required at the time of submitting the enrollment application to establish eligibility
priority for your child(ren) in the program and at the beginning of every semester to verify student status. (See "General
Requirements" section I.)
NOTE:
You will be required to submit original current income verification and/or additional information during the
enrollment process and anytime thereafter.
This Application is Contingent on State Funding for Our Program
Please Note: All Programs are Subject to Change Without Prior Notice
V.
Session Offered:
Each child is required to attend 5 days per week, 3.5 consecutive hours in the Morning or Afternoon
Programs; and 6.5 consecutive hours for the All Day Program.
Semester Session
Age
Group
Hours of Operation
Minimum Hours of Enrollment
Year-round
All Day
2 - 5
8:00 am- 2:30 pm
Monday - Friday
8:30 am - 2:30 pm
Year-round
Morning
* 3 - 5
7:45 am - 11:45 am
Monday - Friday
8:30 am- 11:30 am
Fall Semester
Afternoon
* 3 - 5
12:00 pm - 4:00 pm
Monday - Friday
12:00 pm - 3:30 pm
* Three-year-old will be accepted if there are no four-year-old on the eligibility list
Completing this application does not imply that your child has been accepted into the program
Submit application via e-mail to the Child Development Center at CDC@ELAC.EDU
beginning April 15, 2022 to establish eligibility for your child(ren) in the program
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FOR OFFICE USE ONLY
LOS ANGELES COMMUNITY COLLEGE DISTRICT
Date Application Received: _____________
EAST LOS ANGELES COLLEGE
Child Protective Services: _____________
CalWORKs: _________ Other: ___________
CAMPUS CHILD DEVELOPMENT CENTER
Staff Initials: ___________________________
TODDLER_____ PRE-K_______ TK/KINDER_____
APPLICATION FOR ENROLLMENT
The following will be required: Current family's income verification (1 month's worth), a utility bill (gas, electricity,
trash, or water) and child's birth certificate for all children under the age of 18 who are part of your household
will be required to be submitted with this application. (Submit scanned copies of required documents to CDC@ELAC.EDU)
1.
Child's Name - Last, First, Middle Age
2.
Child's Name - Last, First, Middle Age
3.
Child's Name - Last, First, Middle Age
City
City
1. Yes No
2.
a.
b.
PART I - Child Information:
Address
( )
Student e-mail address (non-student: current email)
Parent #1/Guardian's Name
( )
Birthdate
Birthdate
Birthdate
Parent's/Guardian's Information:
( )
Cell Phone Number
Zip Code ( include 9-digit zip code)
Mark this box, if a text can be send
Address
Home Number
I am interested in applying for:
Year-Round:
Student e-mail address (non-student: current email)
( )
Cell Phone Number
July 1, 2022 - June 30, 2023
Mark this box, if a text can be send
PART III - For CalWORKs/TANF Participants Only:
Are you an active participant of the East Los Angeles College CalWORKs Program?
Which of the following are you currently receiving?
PART IV - How Did You Hear About The Child Development Center? (check all that apply):
Campus Department: Admissions CalWORKs ELAC Website
other:_______
TANF CalWORKs
Check all that apply: Family or Friend Sibling attended Resource and Referral Agency
PART II - Program:
Parent #2/Guardian's Name
Home Number
Zip Code ( include 9-digit zip code)
For Office Use:
Income: Family Size:
Rank:
4/15/2022
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A. Student Status:
●
Current Class Print-out, Educational Plan,
and Semester Final grades: If applicable, a current enrollment verification,
educational plan, and final grades will be required at the time of submitting the enrollment application to establish eligibility
pr
iority for your child(ren) in the program and at the beginning of every semester to verify student status. (See "Gener
al
R
equirements" section I.). IF APPLICABLE: PLEASE PROVIDE YOUR LACCD STUDE
NT
ID
ENTIFICATION NUMBER BELOW
.
Student Non-Student
What is your major:___________________________
Semester
Summer
Fall
Winter
Spring
1 Are you a single parent family? Yes No
2
Name
Date of Birth $
1 $
2
$
3
$
4
Name of College
Parent #2/Guardian
Please check one of the following:
* Enrollment Days and Times are Subject to Change.
Afternoon Session (3 - 5 yrs. old)
*Starting Fall 2022 Semester
12:00 pm - 4:00 pm, Mon.-Fri.
min.12:00 pm -3:30 pm)
Spring
for enrollment. Full- Day Program enrollment will be based on verified family's eligibility and need for services *
Please check all that apply. Indicate the source of income amount for each one:
C. Certification:
* All Day Session (2 - 5 yrs. old)
7:45 am - 3:30 pm, Mon. - Fri.
(min. 8:30 am - 2:30 pm)
Program Selection: Place a check mark next to the program (s) that you would like your child to be considered
7:45 am - 11:45 a.m. Mon.-Fri.
(min. 8:30 am - 11:30 am)
Total Number of Family Members:_________________
List below other children of your immediate family
and provide the following information:
Winter
Units Enrolled
LACCD STUDENT ID #:
LACCD STUDENT ID#:
Date
I certify to the best of my knowledge that the above statements are true. I understand that providing misleading or fraudulent
information are grounds for denial and/or termination of services. I understand that I have the right to appeal the denial of my request
f
or services.
Parent/Guardian(s) Signature
Did you apply at this Center last year? Yes No
Student Non-Student
What is your major:__________________________
Semester Units Enrolled Name of College
Parent #1/Guardian
Please check one of the following:
Morning Session (3 - 5 yrs. old)
3. Unemployment:
2. TANF/CalWORKs:
1. Employment:
Total Gross Monthly Income:
$
B. Total Family and Source of Family Income:
Summer
Fall
4. Other/Specify:
PART V - Children's Enrollment in the Program:
Completing this application does not imply that your child(ren) has been accepted into the program.
Submit application to the Child Development Center via e-mail: CDC@ELAC.EDU beginning
April 15, 2022 to establish eligibility for your child(ren) enrollment in the program.
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LOS ANGELES COMMUNITY COLLEGES DISTRICT
CHILD DEVELOPMENT CENTER
Fraud Statement
This program defines fraud as an intentional misrepresentation, concealment, or
nondisclosure of information for the purpose of inducing Center Staff to rely on it for
determining eligibility for services.
Subsidized child development services are not an entitlement; families must meet
eligibility requirements. Ultimately, the burden of proof of eligibility is on the parent, not
the Center. If the parent cannot prove eligibility, the Center has no obligation to serve the
family. At any step in the completion of the enrollment process or child’s attendance in
the program, services may be suspended, if fraud is substantiated. Documentation of
fraud will be forwarded to the General Legal Council of the Los Angeles Community
Colleges District (LACCD). If a family has obtained services through fraud, payment of
outstanding balance of tuition is required before any future services are considered.
The Center may verify information/documentation provided by the parent.
I understand the above fraud statement and declare, under the penalty of perjury, that the
information and documentation I have provided, is true and correct to the best of my
knowledge. I give LACCD Child Development Center permission to verify all information
provided.
_________________________ _____________________
Child’s Name Parent’s Name
_________________________ ______________________
Parent’s Signature Date
__________________________________
Agency Representative/Director’s Signature
rsvd. April 15, 2022
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Completed 29 April 2022

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