Program Inquiry
Thank you for your inquiry into the Early Childhood Education Center at Concordia
University Chicago. We look forward to being a part of your child’s learning journey.
PARENT(S) Name *
Your answer
Child Name: *
Your answer
Please Check the Box that Applies *
Required
Child Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Email *
Your answer
Phone 1 *
Your answer
Phone 2
Your answer
PROGRAM INTEREST
T/TH
M/W/F
M-F
Infant (6 wks.-15 mos. old / 7 a.m. - 6 p.m.)
Toddler (15-24 mos. old / 7 a.m. - 6 p.m.)
Younger Full Day (2 yrs. old / 7 a.m. - 6 p.m.)
Preschool Full Day (3-5 yrs. old / 7 a.m. - 6 p.m.)
Preschool Morning (3-5 yrs. old / 9 - 11:30 a.m.)
PROGRAM INTEREST
PROGRAM INTEREST
AM (8:45 - 11:45 a.m.)
PM (12:15 - 3:15 p.m.)
Kindergarten Half Day (5-6 yrs. old)
WAIT LIST REQUEST *
Required
IMPORTANT NOTE:
IMPORTANT NOTE: Parents will be notified of program openings via the contact information listed on this form. Please call the ECEC should any contact information change.

708-209-3099 | 7400 Augusta St., River Forest, IL 60305 | crfecec@CUChicago.edu | CUChicago.edu/earlychildhood
Concordia University Chicago ECEC admits students without regard to sex, creed, race, color, national or ethnic origin or handicap.

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