FGCU: Family Resource Center - Initial Application

Initial Application

Please complete this application if you wish to enroll your child in the Family Resource Center's early care and education program. You will be contacted to complete a Comprehensive Enrollment Application when there is space available. Until that time, your child is on the waiting list. To review the Enrollment Selection Guidelines, click here .

A $15 fee must accompany each child's application in order to confirm your placement on the waiting list (i.e., $30 for two children). Mail your check or money order to:

Family Resource Center
10501 FGCU Blvd. South
Fort Myers, FL 33965-6565

Your child(ren)'s name must be on your check. The date your check is received will be your application date.

Requested starting date:

Parent's status (check one):

*1. I am currently a student at FGCU taking credit hours.

*2. I will be a student at FGCU starting the semester indicated below (my application has been submitted to the registration office):

Fall '00
Spring '01 Summer '01

Fall '01
Spring '02 Summer '02

3. Permanent faculty or staff of FGCU.

4. Community-at-large (including adjunct professors and OPS staff of FGCU).

*Student Status: To qualify for student status, you must take a minimum of 6 credit hours (undergraduate) or 3 credit hours (graduate). To maintain your student status you must take classes during the Fall and Spring semesters.

Rates: No matter how many hours per week your child is in the Center the tuition is the same. For example, a student parent pays $77.50/week for a preschool slot whether the child is in the center 10 hours a week or 30 hours a week. Check the Center's current rates at http://www.family.fgcu.edu.

Program Hours: Even though our center does not have required program hours, we highly recommend that the hours your child attends include 9:00 a.m. - 12:30 p.m. These hours include all of the educational activities that promote the different areas of children's development.

Parent/Guardian Name:	,		.
	Last	First	MI

Parent's Social Security Number or Student ID: - -

Home Address
Street Address
City	, FL		Zip
Home Phone		Work Phone
E-Mail Address

(If this application is for an unborn child, include last name only. Use due date for date of birth.)

Child's Name:	,		.	Sex:	Male	Female
	Last	First	MI

Child's Age:
	Years	Months

Child's Date of Birth:	,

The Center is committed to enrolling a diverse community of learners from a variety of backgrounds. Please indicate any background information pertaining to your child's race, religion, and/or national origin. It is understood that providing such information is voluntary in nature.

Children with a diverse range of abilities are welcome at the Center. Does your child require special education considerations as a result of one or more of the following? Check all that apply.
	Physical, visual, speech or hearing difficulties	Chronic health impairments
	Emotional or behavioral difficulties	Other special education needs (explain)
	Learning difficulties

Will your child need assistance to become proficient in English?	Yes No
If you answered "Yes," what is the primary language your child speaks?
Do you think your child is eligible for the Head Start Program?	Yes No
(For more information about Head Start eligibility, contact Christina Joyce, Office Manager, at 239-590-7855)

Please indicate below the estimated days and times of your child's arrival and departure.

	Monday	Tuesday	Wednesday	Thursday	Friday
Arrival
Departure

Does the child for whom you are applying have a sibling currently enrolled in the program or one who would be entering at the same time? (Please complete a separate application for each child.)

Yes No If yes, indicate sibling's name(s):

How did you learn about the Family Resource Center? (Please check all that apply.)

Television Radio Newspaper

Friend Student Services Family Resource Center

Internet Telephone Directory Other:

I would be interested in the following parenting resources. (Check all that apply.)

Borrowing children's books Borrowing books on parenting

Parent information on the Internet Parenting classes

Child care exchange with other families Parent networking

Information and referral regarding community services

Other:

If financial assistance becomes available, would you be interested in applying?
Yes No

I understand that parent participation is essential at the Family Resource Center. If my child is enrolled in the Center, I will agree to become actively involved in some manner. My participation will be discussed upon my child's enrollment.

Please indicate additional information below:

Form Last Updated 09/14/00.

© FGCU 2000. This is an official FGCU Web page. Florida Gulf Coast University is an equal opportunity/affirmative action institution. 10501 FGCU Blvd. South, Fort Myers, FL 33965-6565 webmaster@fgcu.edu Florida Gulf Coast University is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools (1866 Southern Lane, Decatur, Georgia 30033-4097: Telephone number 404-679-4501) to award associate, baccalaureate, and master's degrees.