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

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


Child
Child's Name:  
Note: Each child requires his/her own application
Child's Birthdate:   Write as month/day/year
Note: Children entering the program must be at least 3 months old and not yet Kindergarten
eligible 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
Note: The school year begins in August, though spaces may become available throughout
 the year as vacancies occur.
Siblings currently enrolled in UCB ECEP:
Parent/Legal Guardian 1 Information
Parent/Legal Guardian1 First Name *:
Parent/Legal Guardian1 Last Name *:
UC ID Number (if applicable):
Job Title:
Cell Phone:
Work Phone:
Work Address:
Dept:
Email Address* :
Re-enter Email Address *:
Parent/Legal Guardian 2 Work Information
Parent/Legal Guardian2 First Name:
Parent/Legal Guardian2 Last Name:
UC ID Number (if applicable):
Job Title:
Cell Phone:
Work Phone:
Work Address:
Dept:
Email Address:
Re-enter Email Address:
Affiliations
Check ALL boxes that apply *: Parent/Legal Guardian is a UCB faculty or staff member
Parent/Legal Guardian is a UCB postdoc
Parent/Legal Guardian is a UCB visiting scholar
Parent/Legal Guardian is LBNL, UCOP, or 'other UC campus' faculty or staff member
Parent/Legal Guardian is a community member
Notes
Any additional notes you want to include:
Additional Information
By checking the following boxes, as Parent or Legal Guardian, you agree to the application and enrollment policies.

* Your online confirmation of your application payment is your receipt. Please retain for your records.
* You are responsible for notifying us of any updates to your contact information. (ecep@berkeley.edu)
* Applications remain active until:
  • The child is enrolled in the program (If you choose to leave the program and wish to re-enroll,
    you will need to reapply to be added back to the waiting list.),
  • You ask to be removed from the waiting list,
  • You do not respond to 2 email contact attempts,
  • You decline 3 enrollment offers.
* 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://ece.berkeley.edu, or update your information contact ECEP at 510-642-1827, or e-mail ecep@berkeley.edu.