ECLC 2020-21 Application
2020-21 Applications are due to Roosevelt Elementary by March 12, 2020. Applications received after March 12, 2020 will be reviewed for consideration based on space available on class rosters.
Please call us at 712-225-6760 if you have further questions.

For more information please use this link: https://docs.google.com/document/d/1Q3UTEYSulB0EmPb0fFCZxk5d5fYhwcEC0ecy44kkaSI/edit?usp=sharing
Child's Name *
Your answer
Child's Birthdate *
Your answer
Mother's Name *
Your answer
Father's Name *
Your answer
Child's Address *
Your answer
My child lives with *
Mother's Phone Number *
Your answer
Father's Phone Number *
Your answer
How old will your child be on September 15, 2020? *
Please list any special health or medical needs your child might have.
Your answer
We will work to honor as much request for preference as possible while still maintaining balanced class sections. Please indicate if you have a preference for AM or PM sessions. *
If you are applying for a 3 year old: Do you think you may qualify for financial assistance?
Please add any other comments we may need to know for placing your student into our program.
Your answer
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