NIC Children's Center Waitlist Application

Date
Child's Name
Gender Male      Female
Date of Birth
Child's Name
Gender Male      Female
Date of Birth
Child's Name
Gender Male      Female
Date of Birth
If you have multiple children, are you willing to enroll only one child into the program? Yes      No
Parent Name 1
Home Phone
Cell Phone
E-mail Address
Parent Name 2
Home Phone
Cell Phone
E-mail Address
Mailing Address
City
State
Zip
E-Mail Notice All enrollment updates are sent via e-mail. If you do not have regular access to e-mail, please check here and all updates will be sent to your mailing address.
Enrollment Status
NIC Student (6+ credits)
NIC Student (<6 credits)
NIC Employee
U of I/LCSC student or employee
Care Needed
M-F Full Days
M/W/F Full Days
T/Th Full Days
M-F Half Days - Students Only (<5 hours)
M/W/F Half Days - Students Only (<5 hours)
T/TH Half Days - Students Only (<5 hours)
Semester      
The Children's Center is a Head Start partner and reserves a limited number of slots for Head Start children.
Head Start
The Children's Center is a Head Start partner and reserves a limited number of slots for Head Start children.		 Are you currently on the Children's Center's Head Start wait list (done through Head Start)?
     
Is your child age 3 or 4 after September 1st?
     
If yes, check here for more information about Head Start and the benefits of being in a Head Start slot at the Children's Center?