UCSD Mesa Child Care Center
Application For Part-time Child Care

For children 2½ to 5 years old (opening March 2009)

(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)
 
Part-time Program Requested:
 
Name(s) of your other children currently enrolled at UCSD child care:
  First Name                        Last Name
Child 1:
Child 2:
Child 3:
 
 
Parent/Guardian 1
First Name:
Last Name:
Home Phone Number:
Work Phone Number:
Address:
City: State: Zip:
Employment Status:
UCSD Affiliation:
 
   
Parent/Guardian 2
First Name:
Last Name:
Home Phone Number:
Work Phone Number:
Address:
City: State: Zip:
Employment Status:
UCSD Affiliation:
 
 
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.
 
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:
 
 
© 2008, Regents of the University of California. All rights reserved