| University of Maine
Children's Center 113 College Avenue Orono, ME 04473 Telephone/Fax: (207) 581-4076
PRELIMINARY
CHILD CARE APPLICATION |
(FOR OFFICE USE ONLY)
Databased by ___________ |
Child's Name:
_________________________________________________________
Birth Date: ____________________________________Male:______ Female:______
Parent Name: ________________________________________________________
Parent Name: ________________________________________________________
Mailing Address: ______________________________________________________
Home Telephone Number: _______________________________________________
Parent Contact Telephone Number/s: ______________________________________
_____________________________________________________________________
Parent's University of Maine status:
___currently UM (Orono) student ___future UM (Orono) student (state
date:_______)
___classified as a Maine resident
___foreign student w/@green card@ status or child a U. S. citizen
___full-time undergraduate student (12 credits or more per semester)
___part-time undergraduate student (less than 12 credits per semester)
___full-time graduate student (6 credits or more per semester)
___part-time graduate student (less than 6 credits per semester)
___currently UM (Orono) employee
___full-time regular employee
___part-time regular employee
___temporary employee
___no University of Maine (Orono) affiliation
Parent's University of Maine status:
___currently UM (Orono) student ___future UM (Orono) student (state
date:_______)
___classified as a Maine resident
___foreign student w/@green card@ status or child a U. S. citizen
___full-time undergraduate student (12 credits or more per semester)
___part-time undergraduate student (less than 12 credits per semester)
___full-time graduate student (6 credits or more per semester)
___part-time graduate student (less than 6 credits per semester)
___currently UM (Orono) employee
___full-time regular employee
___part-time regular employee
___temporary employee
___no University of Maine (Orono) affiliation
Type of Child Care Slot Requested:
____ Private ____Subsidized ____ASPIRE ____Voucher
If subsidized, indicate if you wish your child to be considered for special needs or very low income priority status.
____ Special Needs (Children with a specific diagnosis/disability which, without intervention, may
impede or impair the attainment of developmental milestones.
____Very Low Income (Children from very low income working families whose gross income, adjusted
to family size, does not exceed 100% of the Federal Poverty Guidelines.)