Child Development Research Center

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Parents or Guardian Name(s):

Name of Child:

DOB (or due date):

Gender

Female

Male

Name(s) of siblings (currently enrolled or in applicant pool):

Address:

City:

State

Zip:

Parent or Guardian Name:

Work or Home Phone:

Cell Phone:

E-mail:

Parent or Guardian Name:

Work or Home Phone:

Cell Phone:

E-mail:

Enrollment Preference:

Full Time

MWF

TTh

Flexible/call for any

Race/Ethnicity of child:

White

Hispanic/Latino

Asian/Pacific Islander

Black or African American

Native American or American Indian

Other

If Other, please specify:

Language(s) spoken in the home:

Special Needs:

Yes

If yes, please describe:

Family Structure: if other, please describe:

Annual Family Income:

Below $20,000

$20,000-$39,999

$40,000-$74,999

$75,000-$124,999

$125,000-$199,999

Over $200,000

Financial Support

A limited number of financial support opportunities are available.

Financial Support

Currently receiving CCS funding

Have applied for CCS funding

Will apply for tuition assistance through CDRC

Not Applicable

PARENTS, please note: Children are NOT enrolled on a first-come, first-served basis. Selection of children is based on a comprehensive approach with considerations in achieving diversity: gender, age, race, ethnicity, special needs, family structure and family income for the purpose of providing a high-quality teacher training and research program. By signing this form I am acknowledging that I have received and understand the application policies and procedures. I understand that my $50 application fee is due each year of application, does not imply eventual enrollment, and is non-refundable. Traditionally, there is a high ratio of children applying to the number of spaces available. Complete policies may be requested from the CDRC office and are available on the CDRC website: www.cdrc.ttu.edu.

I understand the disclosure above:

Yes

Application Fee

Please remember that your application is not complete until the $50 application fee has been received. You will automatically be re-directed to a secure payment site upon submission of this application.

The application fee is NONREFUNDABLE.

Please note that the CDRC receives many more applications for enrollment than we have spaces become available each year. Completing an application is necessary before enrollment consideration can be made. However, it is certainly not ever a guarantee for enrollment.

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Child Development Research Center

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