ELC Waitlist Form : Tacoma Community College

Parent Information

Parent Name*

Address*

City*

State*

Zip Code*

TCC Email

Alternate Email*

Primary Language Spoken*

Secondary Language Spoken

Interpreter Needed?*

No

Yes

Student Status*

TCC Student ID Number (ctcLink)Please fill out if you are a TCC student.

Care Information

When do you need to start child care?*(Your selection does not guarantee enrollment)

Are you currently receiving a DCYF Childcare Subsidy?*

No

Yes

If you are receiving a DCYF Childcare Subsidy, which kind?

Full-time subsidy

Part-time subsidy

Do you think you may qualify as a low income family?*

No

Yes

Check all that apply.

Homeless

Child in Foster/Kinship Care/Adopted

Receiving TANF CASH

Pell Grant

Transfer from current EHS/ECEAP/HS program

Child or parent receiving SSI

IFSP/IEP

ECLIPSE

ESIT

Child Information

Child's Name*

Child's Current Age*

Child's Birthdate/Due Date*

Is your child walking?*

No

Yes

What are your child's pronouns?

I give permission for the ELC to access my ctclink account to verify my student status, prior to calling me for an available childcare opening.*

I agree

I do not agree

I agree that I'm responsible for updating my information with the TCC ELC if it changes.*

I agree

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