Cerro Coso Community College

Child Development Center Application Form

Preliminary Application

Please fill out all of the following information.

Parent/Guardian Information
Parent/Guardian A
Parent/Guardian B
Physical Address and Phone for Parent/Guardian living with Child
Child and Family Information
Please list ALL the children in the family.
Child #1
Child #2
Child #3
More Parent/Guardian Information
Needed only if parent/guardian is living with the child
Parent/Guardian A
Please check all that apply
Gross Monthly Income
$
$
$
$
$
$
$
$
$
Parent/Guardian B
Please check all that apply
Gross Monthly Income
$
$
$
$
$
$
$
$
$
Kern Community College District