MSU CDL Initial Application
|
CDL Locations
The MSU CDL has two locations. One location is on MSU's campus in East Lansing and the other is in Haslett attached to Wilkshire Early Childhood Center.
|
| Campus Preference
| East Lansing Campus Haslett Campus Willing to Accept Either
|
Identification
In order to provide the best service, please enter the child's information below.
|
| Child's Name
|
|
| Prefix
|
|
| First
|
|
| Last
|
|
| Suffix
|
|
| Child's Date of Birth
|
|
Contact Information
Please enter your contact information so we may notify you of any availbility in our programs in a timely fashion.
|
| Address
|
|
| Street Address
|
|
| Address Line 2
|
|
| City
|
|
| State / Province / Region
|
|
| Postal / Zip Code
|
|
| Country
|
|
| Home Phone Number
|
|
| Cell Phone Number
|
|
| Primary Email Address
|
|
| Parent/Guardian 1 Name
|
|
| Prefix
|
|
| First
|
|
| Last
|
|
| Suffix
|
|
| Parent/Guardian 1 Employer
|
|
| Parent/Guardian 2 Name
|
|
| Prefix
|
|
| First
|
|
| Last
|
|
| Suffix
|
|
| Parent/Guardian 2 Employer
|
|
Additional Child Information
Please provide, to the best of your ability, accurate information to help us serve your child better.
|
| Have you had children at the CDL in the past?
|
|
| If so, when?
| Enter approximate date
|
| The CDL values the diversity reflected in our families. Does your child speak English as a primary language?
|
|
| If not, what is your child's primary language?
|
|
| The CDL welcomes children of all abilities. In order to plan the best program for your child, please identify any special needs:
| Large Muscle Small Muscle Physical Limitations (wheelchair, walker, etc.) Feeding Epilepsy/Seizure Disorders Allergies Chronic Illness Cystic Fibrosis Cerebral Palsy Multiple Sclerosis Prader-Willi Syndrome Vision Hearing Asperger's Syndrome Attention Deficit Disorder Tourette Syndrome Learning Disabilities/Delays Speech Delay Cognitive Processing Difficulties Down Syndrome Autism Check all that apply.
|
| Other:
|
|
| If your child has a diagnosis, is there an established Individual Education Plan (IEP)?
|
|
| If yes, which school discrict?
|
|
MSU CDL Program Selection
The MSU CDL offers a variety of programs for your child.
|
| Please check the program in which you are interested.
| Family/Infant Toddler Learning Program - Parent and child class that meets for about an hour and fifteen minutes once per week at our East Lansing campus. Half-Day Preschool Program - For children 2 to 5, Monday through Thursday classes with AM and PM sections offered. Full-Day Preschool Program - For children 18 to 35 months & 3-5 years. Fulltime, year round care at our East Lansing campus. Offered 7:30 AM to 6 PM, Monday through Friday. Half-Day Summer Program - For children 30 months to 5 years, Monday through Thursday classes with AM and PM sections offered.
|
| Date you hope to begin school:
|
|
Thank you for your interest in the MSU CDL.
To help serve future families better, please answer the final question below:
|
| How did you hear about us?
| Friends and Family Internet Newspaper/Magazine Television/Radio Check all that apply.
|
| Feel free to enter any questions, comments or additional information for our staff:
|
|
|
Image Verification
|
|
|
|
|
|
EMF Form Builder
EMF Form Builder