Forms

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Linn County Child Development Center Online Application

  1. How to Submit an Application

    An account is not required to submit a child care application through this website. It is only necessary if you cannot finish the application in one sitting and would like to save it to complete at a later time. To create an account, you will need to enter an email address, then check your email for a confirmation message, use the information in that message to set up a password, then login to the Linn County website. Please call 319-892-5733 with questions.

  2. Child Information

  3. Child's Gender*

  4. Parent Information

  5. Family Income Information

  6. Primary Adult Income Sources*

    Mark all that apply.

  7. Secondary Adult Income Sources

    Mark all that apply.

  8. Family Needs

  9. Does your child have an Individual Education Plan (IEP)?

  10. Has your child previously been in ESL (English as a Second Language) or ELL (English Language Learners)?

  11. Has this child been previously enrolled in the Linn County Child Development Center?*

  12. Has a sibling been previously enrolled in the Linn County Child Development Center?

  13. Is this child living:

  14. In foster care?

  15. In transitional housing or shelter?

  16. With more than one family in a house or apartment?

  17. In a motel, car, or campsite?

  18. With friends/family other than parent/guardian?

  19. Nutrition Assessment

  20. Parent concerns about child eating in the classroom?

  21. Any special diet modification the child must follow (i.e. medical diet, food allergies)?

  22. Any religious dietary restrictions we should know about?

  23. Are you participating in WIC?

  24. Are you able to provide adequate meals for your family (i.e. do you run out of food, does your refrigerator/stove work)?

  25. Special Needs

  26. Suspected Disability?

  27. Professionally Diagnosed Disability?

  28. Documented diagnosis/verification included with application?

  29. Special Health Concerns

  30. Do you have any special health concerns regarding your child?

  31. Behavioral/Social Concerns

  32. Do you have any behavioral/social concerns regarding your child?

  33. Leave This Blank:

  34. This field is not part of the form submission.