APPLICATION FOR ENROLLMENT
Early Childhood Education Program
University of California, Berkeley • http://www.housing.berkeley.edu/child

Attention: Cashiers: #1-48120-67400-18934--UJCENT-UJAPP


Child
Child's Name:  
Child's Birthdate:   Write as month/day/year
Note: Children entering the program must be at least 3 months old in mid-August of the year of enrollment.
Child's Sex:   Male
Female
Date you would like child to
START being considered for entry:
Write as month/day/year
Siblings in UCB ECEP:
Centers/Dates:
Home Address
Home Address:*
City/State/Zip/Country:*
Home/Work/Cell Phones:*
Parent 1 Work Information
Parent1 First Name:
Parent1 Last Name:
UC ID Number (if applicable):
UC affiliation (job title)
Work Phone:
Work Address:
Dept:
Email Address:*
Re-enter Email Address:*
Parent 2 Work Information
Parent2 First Name:
Parent2 Last Name:
UC ID Number (if applicable):
UC affiliation (job title)
Work Phone:
Work Address:
Dept:
Email Address:
Re-enter Email Address:
Affiliations
Check ALL boxes that apply: Parent is a UCB faculty or staff member
Parent is a UCB postdoc
Parent is a UCB visiting scholar
Parent is LBNL, UCOP, or 'other UC campus' faculty or staff member
Parent is a community member
Scheduling
Some centers operate on a year-round basis, with short breaks between semesters. Other centers are open only during the academic year (generally late August to late May).

Please indicate your scheduling needs below. Check all boxes that apply:
I am only interested in a year-round program
I am only interested in an academic calendar year program
I prefer a year-round program but would accept an academic calendar year program
Notes
Any additional notes you want to include:
Additional Information
General Information

  • Applications are accepted at any time, early applications are advisable.
  • Enrollment generally occurs in August, though spaces are available throughout the year as vacancies occur in our centers.
  • Applications remain active until child is admitted to program, parent asks to be removed from the waiting list or parent does not respond to 3 contact attempts.
  • Children enrolled in ECEP centers may participate in teaching and research programs administered by the University.
Please note that filing an application does not ensure that we will be able to provide services to you. All information will be kept strictly confidential by the UCB Early Childhood Education Program.

For further information and fees please see our website: http://www.housing.berkeley.edu/child, or contact ECEP at 510-642-1827, or e-mail ecep@berkeley.edu.