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Application for Admission
Siemens CDC, an early childhood community (formerly Mentor Graphics CDC)
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* Indicates required question
Email
*
Your email
Child's First and Last Name ("Baby" and last name if unknown)
*
Your answer
Birth date or Due date
*
MM
/
DD
/
YYYY
Child's Sex
*
Female
Male
Unknown
Enrollment Schedule Requested
*
The CDC offers full days only. Full day schedules other than those listed may be available by special arrangement. Please indicate your preferred schedule of days under "Other"
Full Time (M-F)
MWF
TUTH
Any Part-Time
Other:
Enrollment start date requested
*
MM
/
DD
/
YYYY
First Parent/Guardian's Name (pronouns)
*
Your answer
Email
*
Your answer
Primary Phone Number
Your answer
Employer
*
Siemens
Siemens Contractor
Other:
Required
Second Parent/Guardian's Name (pronouns) -please write 'none' if there is only one legal parent/ guardian.
*
Your answer
Email
*
Your answer
Primary Phone Number
Your answer
Employer
Siemens
Siemens Contractor
Other:
Preferred Mailing Address (including city and zip code)
*
Your answer
Does the child have a Grandparent who is a Siemens employee?
*
Yes
No
Do you currently have concerns about your child's development or behavior?
*
Yes
No
If yes, please describe.
Your answer
Is your child currently receiving developmental services (Speech, OT, PT, etc.)?
*
Yes
No
A copy of your responses will be emailed to the address you provided.
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