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Home
About
Board of Directors
Staff
Chief Executive Officer
Senior Staff
Founder
Calendar of Events
Newsletters
Blog
Programs
Child Development
Black Infant Health
CalFresh
Food Program
FamilySource Center
Locations
Careers
Careers
Employee Personnel Manual
Contact
Donate
More Info
VAN NESS Waitlist Enrollment Form
Which program are you interested in?
(Required)
Infant program (6 weeks - 24 months)
Toddler program (18 - 36 months)
Preschool program (2-5 years)
Do you currently have other children enrolled in any TCCI childcare sites? Select all that apply.
(Required)
Casa Childcare Center - 15711 S Atlantic Blvd, Compton, CA 90221
Florence Childcare Center - 7217 S Mace Place, Los Angeles, CA 90001
Hope Childcare Center - 3401 Somerset Dr, Los Angeles, CA 90016
King-San Pedro Childcare Center - 3817 S San Pedro St, Los Angeles, CA 90011
McAlister Infant Toddler Center - 4525 Pinafore St, Los Angeles, CA 90008
Rita Walters Childcare Center - 932 W 85th St, Los Angeles, CA 90044
Vermont Childcare Center - 10441 S Vermont Ave, Los Angeles, CA 90044
Willowbrook Childcare Center - 12829 S Jarvis Ave, Los Angeles, CA 90061
I don't currently have any children enrolled in any TCCI childcare sites.
Parent/Guardian Information #1
First & Last Name:
(Required)
Email
(Required)
What is your home language?
(Required)
English
Spanish
Other
Phone Number:
(Required)
Address
Street Address
City
ZIP / Postal Code
Which describes your household?:
(Required)
Single parent/guardian
Two parents/guardians
Foster parent
Other
Parent/Guardian Information #2
First & Last Name:
Email:
Home language:
English
Spanish
Other
Phone Number:
Reasons for Needing Childcare:
Check all that apply.
Parent/Guardian #1:
(Required)
Working
Attending school/job training
Seeking employment
Incapacitated (mental or physical disability)
Homeless/seeking housing
Currently living in a shelter
Part-day educational preschool experience for your child(ren)
Parent/Guardian #2
Working
Attending school/job training
Seeking employment
Incapacitated
Homeless/seeking housing
Currently living in a shelter
Part-day educational preschool experience for your child(ren)
Child Needs
Check all that apply to the child being enrolled.
(Required)
Are you interested in full-time? (4 or more hours)
Are you interested in part-time? (less than 4 hours)
CPS/At risk
Foster child
IEP (ages 3 and up)
IFSP (ages birth to 3)
Special needs
Government Assistance
What types of aid are you currently receiving?
(Required)
Cash Aid
Medicaid
Temporary Assistance for Needy Families (TANF)
Supplemental Security Income (SSI)
CalFresh
California Food Assistance Program (CFAP)
CalWORKs
Cash Assistance Program for Immigrants (CAPI)
Medi-Cal
Children's Health Insurance Program (CHIP)
Women, Infants, and Children (WIC)
I am not currently receiving government assistance.
The income I used on the application for this Means Tested Program is:
Please list dollar amount.
Days & Hours of Employment:
Indicate the hours worked on the days listed (i.e. 8am - 4pm). If no hours are worked, leave blank.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Add
Remove
If you'd like to add hours worked for a second parent/guardian, click the (+) sign to add a second row.
Days & Hours of School/Training:
Indicate the hours spent at school or job training (i.e. 8am - 4pm). If no hours are worked, leave blank.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Add
Remove
If you'd like to add school or training hours for a second parent/guardian, click the (+) sign to add a second row.
Total Gross Monthly Income:
If more than one parent/guardian, please list individual gross monthly income of each parent/guardian.
Parent/Guardian #1:
(Required)
Parent/Guardian #2:
Children Living in the Home
List all children under 18 who are members of the family.
Child #1 - First & last name:
(Required)
Gender
(Required)
Female
Male
Other
Date of birth
(Required)
MM slash DD slash YYYY
Child #2 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #3 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #4 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #5 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #6 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #7 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #8 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #9 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
Child #10 - First & last name:
Gender
Female
Male
Other
Date of birth
MM slash DD slash YYYY
How did you hear about us?
(Required)
Community Events
Staff
Former or current family
Postcard
Email
Flyer
Website
Social Media
DCFS
CDSS
Medical clinic
WIC
TCCI's FamilySource Center (FSC)
Other
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