CHILD STUDY CENTRE
Department of Elementary Education
University of Alberta

APPLICATION FOR 1997-98

Name of Child 	______________________________ Sex of Child _____________

Address	_________________________________________________________________

_________________________________________________________________________
							    postal code
	             																																																																																		      	 Postal Code
Date of Birth  ________________________

Home Phone  ______________________  Cellular Phone  ______________________

Name of Mother ____________________ Business Phone _______________________

Name of Father ____________________ Business Phone _______________________

Attended '96-97 Program:  Yes    No

Has Sibling Attended Program:  Yes   No  -- Year attended: _______________

Program Requested:

 	Junior Kindergarten	  Morning	     Afternoon	   Either
 	Kindergarten		  Morning            Afternoon	   Either

*Will Child be attending another
 ECS/kindergarten program?:          Yes   No   Maybe

  Grade One
  Grade Two

Please describe the nature of any special needs your child may have
(i.e. medical, developmental, visual, auditory) which would require
 specific attention in program planning.

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Mail or drop off Completed application form to:

     	Marilyn Hawirko
	Child Study Centre
	Department of Elementary Education
	Room B03 Education South
	University of Alberta
	Edmonton, Alberta  T6G 2G5

Please include:

	* copy of your child's birth certificate 
	* $40 non-refundable application fee  cheque payable to
 	  Department of Elementary Education

Parents will be notified by April 30th whether or not their child has been
accepted into the program and which class the child has been assigned to.
The September monthly fee will be required to be paid by May 15th to confirm
the child's place.