WAIT LIST APPLICATION

WASHINGTON STATE UNIVERSITY VANCOUVER
CHILD DEVELOPMENT PROGRAM
14204 NE Salmon Creek Avenue
Vancouver WA 98686
360/546/-9722
FAX: 360/546-9076
http://www.vancouver.wsu.edu/hd/cdp.htm
email: wsuvcdp@vancouver.wsu.edu

Child's Name: _____________________________________________________________________________
 

Child's Birth Date _______________________

M

F

(Please indicate child's sex by circling appropriate letter)

Child's Home Address: _______________________________________________________________________

Child's Home Phone: _____________________ E-mail Address: _______________________________________

Parent/Guardian Name(s): _____________________________________________________________________

Relationship to child: ______________________________________________ Siblings attended CDP? Yes or No

Day Phone: _____________________________ WSU Student/Faculty/Staff?______________________________

Are you now receiving or do you plan on applying for a Washington State

Department of Social and Health Services Child Care Subsidy?

Yes

No

PLEASE NOTE: You are responsible for informing us in writing of any changes in address or telephone number.
The program will cancel the application if the parent cannot be located.

WSU Vancouver's Child Development Program is open to children of students, staff, faculty and the general public. We accept children 3 to 5 years of age on a first come, first served, space available basis.Children must be 3 years ofage on or before August 31st for admission.APPLICATION DOES NOT INSURE FINAL ADMISSION. Upon completion of this application your child will be placed on a waiting list.

USDA STATEMENT: In cooperation with the Child Care Food Program, no child will be discriminated against because of race, color, handicap, age sex, religion, or national origin. If you believe you have been discriminated against in any USDA-related activity, you should write immediately to the Secretary of Agriculture, Washington D.C. 20250.

 
 Signature:______________________________________________ Date: ______________________________
 

  Washington State University Vancouver
Child Development Program
2007-2008 Academic Year

 
Overtime Charges: Assessed for any amount of time your child is present before or after scheduled hours. Overtimes rates are $1.00 per minute after 6:00pm.

Payments for scheduled hours must be made in advance, no later than the tenth of each month. A $10 late payment fee is assessed for bills not paid by the tenth of each month. Tuition payments must be made in full via personal check, money order, or cashiers check. Alternative payment schedules can be discussed with the Administrative Assistant.

Tuition has been figured at a rate that does not include days the program is closed for winter break, spring break and summer break. Therefore, the full monthly tuition remains the same regardless of whether the program is closed.

Make checks payable to Washington State University and deliver or send them to:

Child Development Program
Washington State University Vancouver
14204 NE Salmon Creek Avenue
Vancouver, WA 98686

When are you interested in starting: _________________________________________________________________