FAMILY MATTERS

Worksheet and Handout

Inform the students that applications are also necessary to enroll their children at day care centers. Give them the following information to complete. Tell the class that these questions are likely to appear on a day care application form.

1. Full Name of Applicant (last, first, middle)

2. Address (number and street, apt. no)

3. City

4. Zip Code

5. Marital Status (never married, married, divorced, separated, widowed)

6. Home Phone Number

7. Work Phone Number

8. Racial-ethnic heritage: White, not of Hispanic origin; Black, not of Hispanic origin; Hispanic; American Indian; Alaskan native; Asian or Pacific Islander (answer is voluntary)

9. Why do you need child care services? (check all that apply)

        a. To work

        b. To attend high school completion classes

10. List all names and ages of children in your home who need child day care.