ASSOCIATED STUDENTS Child Development Center
WAIT LIST APPLICATION
ASSOCIATED STUDENTS Child Development Center
460 South 8th Street
San Jose, CA 95112
(408) 924-6988 (408) 924-6999 FAX as-cdc@sjsu.edu
Family Information
Application Date: __________________________ Semester desired: ___________
Child’s name: ______________________________ Date of Birth: ___________
Ethnicity: _________________________________ Affiliation: __SJSU Student
Parent’s name: _____________________________ ___Staff __ Faculty__ SJSU Alumni
__ Community
Address: ________________________________________________________________
House number City zip code
Phone number: home____________________ cell _______________________
E-mail address ________________________________Number in family ____________
Second Parent’s name _________________________
Second Parent’s email _________________________
Child’s schedule: Arrive Leave
|Monday | | |
|Tuesday | | |
|Wednesday | | |
|Thursday | | |
|Friday | | |
SJSU STUDENT PARENT ADDITIONAL INFORMATION
Student Parent name _________________________ Major _______________________
Pell Grant Yes__ No__ Expected Degree _____________________
Working Yes___ No___ Expected Date of Graduation ___________
Occupation ____________ Student ID #_______________
Married___ Single_____ Living with relatives____ (check all that apply)
Second Parent name_____________________________ Student Yes___ No___ ______
If a student, where? _________________ Student ID #_______________
Pell Grant Yes___ No__ Major _______________
Living in household Yes__ No__ Expected Degree ______________
Working Yes___ No___ Expected Date of Graduation _____
Occupation _________________________
SJSU student parents may apply for a child care subsidy. The ASCDC needs additional information in order to ascertain if you might qualify. Further documentation will be requested if it appears you may be eligible for subsidized care and if there is a space available for your child. Please let us know the following:
• Gross (before deductions) monthly income and sources:
(Include earnings, child support, unemployment insurance, veteran’s benefits, savings, cash contributions from student parent family, etc.) Also, please circle the source(s) of income.
If both parents are in the household, please give each parent’s gross income and source.
• Financial Aid: Please list your allocation of loans, scholarships, and grants this academic year:
................
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