SUNY Westchester Community College

Virginia Marx Children’s Center Application Form for Enrollment

About Your Child

Child\'s Name

Date of Birth

Home Address

About You

Parent\'s Name

Phone (Home)

Occupation

Employer\'s Name

Employer's Address

Phone (Work)

Phone (Cell)

Parent\'s Name (2)

Home Address

Phone (Home)

Occupation

Employer\'s Name

Employer's Address

Phone (Work)

Phone (Cell)

Are You

Westchester Community College

Full-Time Student

Part-Time Student

Staff

Faculty

If you are staff or faculty, please provide us with your department and your extension

If you are a student, please provide your Student ID

Hours Requested

Full-Time

Part-Time (Student parent - minimum of 20 hours required per week)

Or A

Community Parent

Community Parent Full-Time

Community Parent Part-Time

Note

A non-refundable registration fee is charged for the enrollment of each child:
$75.00 for children of WCC staff, WCC faculty, County Employees & Community Parents
$30.00 for children of WCC student-parents

Westchester Community College, State University of New York

Virginia Marx Children’s Center Application Form for Enrollment

About Your Child

About You

Are You

Or A

Virginia Marx Children Center

Contact Information

Hours of Operation