Student Wait List Application

Please complete the follow application to have your child placed on our waiting list. Please Note: All questions must be answered. If it does not apply to you or your child, select or input 'N/A' - Applications with skipped answers will be discarded.
To be considered for a spot, the following must be turned after your submit your application:
*Recent Well Child Exam
*Recent Dental Exam (1 yr+)
*Immunization Report/or Exempt Letter
*Parent/Guardian ID
*Child Insurance Information
*Medical Documentation if Necessary
*Student Schedule or ID Number

If you have any questions, please call our office at 253.589.5531

***If you have multiple children you would like to place on the wait-list, please fill out an additional application and submit it***

Are you in need of emergency child care services? 

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* 1. Are you in need of emergency child care services? 

Are you able to attend school without child care?

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* 2. Are you able to attend school without child care?

Did you fill out a CPTC Welcome Center intake questionnaire? 

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* 4. Did you fill out a CPTC Welcome Center intake questionnaire? 

**Staff Use ONLY** Contact Documentation **Staff Use ONLY**

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* 5. **Staff Use ONLY** Contact Documentation **Staff Use ONLY**

Child Information

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* 6. Child Information

What is your relationship to the child?

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* 7. What is your relationship to the child?

Primary Contact Information

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* 8. Primary Contact Information

Parent Information

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* 9. Parent Information

What is your CPTC Student ID

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* 10. What is your CPTC Student ID

Secondary Parent/Guardian Contact (If Applicable)

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* 11. Secondary Parent/Guardian Contact (If Applicable)

When do you need care to start?

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* 12. When do you need care to start?

Is your child currently in care? If yes, where? (select all that apply)

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* 13. Is your child currently in care? If yes, where? (select all that apply)

Does any of the following apply to your child? (select all that apply)

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* 14. Does any of the following apply to your child? (select all that apply)

Does your child have, or is in the process of getting: (select all developmental criteria that applies)

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* 15. Does your child have, or is in the process of getting: (select all developmental criteria that applies)

Health and Development (select all that apply)

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* 16. Health and Development (select all that apply)

How will monthly childcare costs be paid?

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* 17. How will monthly childcare costs be paid?

How did you hear about our program?

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* 18. How did you hear about our program?

Current Living Situation (select all that apply)

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* 19. Current Living Situation (select all that apply)

What is your education level? (select all that apply)

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* 20. What is your education level? (select all that apply)

Are you currently in the following? (select all that apply)

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* 21. Are you currently in the following? (select all that apply)

Parent Information (select all that apply)

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* 22. Parent Information (select all that apply)

What programs/support on campus are you using? (select all that apply)

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* 23. What programs/support on campus are you using? (select all that apply)

What is your CPTC Program?

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* 24. What is your CPTC Program?

Are you done with your Pre-Req's?

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* 25. Are you done with your Pre-Req's?

What was your CPTC Start Date? What is your tentative Graduation Date?

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* 26. What was your CPTC Start Date? What is your tentative Graduation Date?

Financial Aid Status (select all that apply)

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* 27. Financial Aid Status (select all that apply)

Do you have any questions or additional information you would like to share with us? Please indicate them below:

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* 31. Do you have any questions or additional information you would like to share with us? Please indicate them below:

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