NIC Children's Center Waitlist Application

Generally, there is about a year wait for families to get into the NIC Children’s Center, although the time frame is never guaranteed.

Status New Application      Update to Previous Application
Child's Name
Gender Male      Female
Date of Birth
Child's Name
Gender Male      Female
Date of Birth
Child's Name
Gender Male      Female
Date of Birth
If you listed multiple children, are you are willing to enroll only one child into the program? If yes, check box:
Does your child have a diagnosed medical condition or disability?
If yes, give a brief description:
What is the primary language spoken in your home?
Will you need interpretive services? If yes, check box:
Alert! Important: Please provide us with current contact information that you check on a regular basis as e-mail and phone calls will be the form of communication used for updates and enrollment into the program.
Parent/Guardian Name
Relationship
Mailing Address
City
State
Zip
Home Phone
Mobile Phone
Work Phone
E-mail Address
Parent/Guardian Name
Relationship
Mailing Address
City
State
Zip
Home Phone
Mobile Phone
Work Phone
E-mail Address
Parent/Guardian
Enrollment Status
NIC Student (6+ credits, eligible for student discount)
NIC Student (3-5 credits)
NIC Employee
Care Needed
M-F Full Days
M/W/F Full Days
T/Th Full Days
M-F Half Days*
M/W/F Half Days*
T/TH Half Days*
* Half day spots are up to 5 hours per day and for NIC students only.

Head Start
The Children's Center is a Head Start partner and reserves a limited number of slots for Head Start children.

Are you currently on the wait list with Head Start ? If yes, check box:

Would you like more information and be interested in a Head Start slot?
If yes, check box: