Child Care Interest Form

The Early Learning Campus (ELC) is a campus-based childcare for children ages 6weeks - 5years. Priority enrollment is granted to student-parents, particularly low-income students, to help them obtain their educational goals.

Indicates required field

Parent/Guardian Information

First Name

Last Name

Telephone

Street Address

City

State

Zip Code

Affiliation

Are you receiving a Pell Grant?

Have you completed the CCAMPIS Scholarship Application?

View the Scholarship/Funding Resources section of our Early Learning Campus page for more details; https://madisoncollege.edu/about/community/facilities/child-care

Yes

Are you receiving child care funding?

Yes

Select all that apply

City of Madison

UW Madison Tuition Assistance (CCTAP)

WI Shares

Other…

Session Information

Preferred Start Term

Year

6 weeks - 4 years (Non-4K) Schedule

Complete if your child is in this age range and NOT enrolled in the MMSD 4K program. There is a two day per week minimum enrollment requirement.

Questions	All Day (7:45-4:45)
Monday	All Day (7:45-4:45)
Tuesday	All Day (7:45-4:45)
Wednesday	All Day (7:45-4:45)
Thursday	All Day (7:45-4:45)
Friday	All Day (7:45-4:45)

Wrap Around Care for 4K Students

Complete for children who are eligible for or enrolled in the 4K program through MMSD. 4K hours are Monday - Thursday 8:30 am - 3 pm.

Questions	Before Care (7:45-8:30am)	After Care (3-4:45pm)	Before and After Care (7:45am-4:45pm)	All Day (7:45am-4:45pm)
Monday	Before Care (7:45-8:30am)	After Care (3-4:45pm)	Before and After Care (7:45am-4:45pm)	All Day (7:45am-4:45pm)
Tuesday	Before Care (7:45-8:30am)	After Care (3-4:45pm)	Before and After Care (7:45am-4:45pm)	All Day (7:45am-4:45pm)
Wednesday	Before Care (7:45-8:30am)	After Care (3-4:45pm)	Before and After Care (7:45am-4:45pm)	All Day (7:45am-4:45pm)
Thursday	Before Care (7:45-8:30am)	After Care (3-4:45pm)	Before and After Care (7:45am-4:45pm)	All Day (7:45am-4:45pm)
Friday	Before Care (7:45-8:30am)	After Care (3-4:45pm)	Before and After Care (7:45am-4:45pm)	All Day (7:45am-4:45pm)

Child Information

Child 1 - Full Name

Child 1 - Date of Birth (or anticipated due date)

Child 2 - Full Name

Child 2 - Date of Birth (or anticipated due date)

Child 3 - Full Name

Child 3 - Date of Birth (or anticipated due date)

Comments

The Submit button is disabled due to your selection of Friday 4K services. The only allowable option is All Day (7:45-4:45). 4K services do not run on Fridays.