Online Application

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Preliminary Child Care Application

Child's Name
Birthdate
MM slash DD slash YYYY
Parent#1 Name
Parent#2 Name
Mailing Address
Street Address City State ZIP Code
Email
Home Telephone Number
Parent Contact Telephone Number(s)
Phone Type (Mobile, Office, etc)

Select the (+) icon to add additional phone numbers
Parent #1 University of Maine Status
- Current UM (Orono) student
- Future UM (Orono) student
- full-time undergraduate student (12 or more credits per semester)
- Part-time undergraduate student (<12 credits per semester)
- Current UM (Orono) employee
- No UMaine (Orono) affiliation
Select employee status:*
- Full-time regular employee
- Part-time regular employee
- Temporary employee
Parent #2 University of Maine Status
- Current UM (Orono) student
- Future UM (Orono) student
- full-time undergraduate student (12 or more credits per semester)
- Part-time undergraduate student (<12 credits per semester)
- Current UM (Orono) employee
- No UMaine (Orono) affiliation
Select employee status:*
- Full-time regular employee
- Part-time regular employee
- Temporary employee
Email

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