The Carole Robertson Center's Waiting List Application

Para la aplicación en español: http://bit.ly/esCRCL_Inscribirse

This is the first step towards enrollment. The application will be kept on file for 1 year from the date completed. Someone will follow up with you shortly. Thanks so much for choosing Carole Robertson Center for Learning.

Question Title

Were you referred by a Carole Robertson Center for Learning Parent or Staff member? (Please enter their name)

Question Title

Application

Date of Application:

Date

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Services

Date Services are needed:

Date

Question Title

Location for Wait List (Select all that apply)

3701 Ogden Ave, Chicago, IL 60623

2929 W 19th St, Chicago, IL 60623

5101 N Kimball Ave. Chicago, IL 60625

Legacy

KIPP Ascend

Question Title

How did you hear about the Carole Robertson Center for Learning? (Select all that apply)

Facebook/Social Media

Carole Robertson Center for Learning's Website

A Carole Robertson Center for Learning Staff Member

Word of Mouth

From a Carole Robertson Center for Learning Parent

Flyer

Other (please specify)

Question Title

Which programs are you applying for? (Select all that apply)

Infant

Toddler

Pre-K

Schoolage: Afterschool and/or Summercamp

Family Child Care Network

Home Visiting

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Contact Information

Parent(s):

Address:

City:

State:

Zip:

Phone (Home):

Phone (Work):

Email Address:

Employer/Company Name:

Employer Address:

Gross Income (Before Taxes) Estimate per Month: