New UCSC Childcare Center Interest Form
*Not a wait pool application*
Your Name
First Name
Last Name
Your Department
Your Position
Your Child(ren) Name (if unborn, please put baby and your last name ex: Baby Smith)
First Name
Last Name
Your Child(ren) Name (if unborn, please put baby and your last name ex: Baby Smith)
First Name
Last Name
Your Child(ren) Birthday or Due Date
-
Month
-
Day
Year
Date
Your Child(ren) Birthday or Due Date
-
Month
-
Day
Year
Date
If you have more children that you wish to add for the interest list, please provide their information in the box below
Your best email for contact
example@example.com
Your best phone number
Please enter a valid phone number.
Anything else to share
*
I acknowledge that this is an interest form for the new campus child care center and not a wait pool application. I will be sent a email when information about the process of the wait pool application is available for the new campus child care center.
Submit
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