APPLICATION FORM FOR CHILDCARE SERVICES
NURSERY AND KINDERGARTEN
For SASUC use only:
File number: _______________________ Reception date: ___ / ___ / ______
Wanted Service: Nursery (2 months old - 3 years old)
Kindergarten (3 - 6 years old)
Attendance period: from dd / mm / yyyy to dd / mm / yyyy
A. CHILD IDENTIFICATION
Name: ________________________________________________________________________
Gender: M
F
Birth date: dd / mm / yyyy Nationality: _________________
Taxpayer Identification Number: _________________
Filiation:
Mother/Father 1: _________________________________________________________________
Address: _______________________________________________________________________
Postal code: ______ - ____ Locality: _________________________________________________
Phone: ______________ Mobile phone.: _______________ E-mail: _________________________
Mother/Father 2: _________________________________________________________________
Address: _______________________________________________________________________
Postal code: ______ - ____ Locality: __________________________________________________
Phone: ______________ Mobile phone.: _______________ E-mail: _________________________
Other contact person:
Name: _________________________________________________________________________
Kinship: ________________________________________________________________________
Address: _______________________________________________________________________
Postal code: ______ - ____ Locality: __________________________________________________
Phone: ______________Mobile phone: _______________ E-mail: ___________________________
Guardian: Mother/Father 1
Mother/Father 2
Other (above mentioned)
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B. PARENT/LEGAL GUARDIAN’S ACADEMIC OR PROFESSIONAL STATUS
a) Students
Faculty or Institute:
Mother/Father/Legal Guardian 1 __________; Mother/Father/Legal Guardian 2: __________
Degree:
Mother/Father/Legal Guardian 1: __________; Mother/Father/Legal Guardian 2: __________;
Year of attendance:
Mother/Father/Legal Guardian 1: __________; Mother/Father/Legal Guardian 2: __________;
Student nº:
Mother/Father/Legal Guardian 1: __________; Mother/Father/Legal Guardian 2: __________;
b) Non students
Employer Service/Company:
Mother/Father/Legal Guardian 1: ______________; Mother/Father/Legal Guardian 2: ______________;
Do they have ties to the UC? Yes
No
Who has ties? Mother/Father/Legal Guardian 1
Kind of tie? Teacher
Non-teaching staff
Have they had ties to the UC? Yes
Mother/Father/Legal Guardian 2
Researcher
No
Who has ties? Mother/Father/Legal Guardian 1
Kind of tie? Teacher
Non-teaching staff
Mother/Father/Legal Guardian 2
Researcher
Student
C. HOUSEHOLD COMPOSITION
Kinship
Name
Age
Marital
status
Academic
qualifications
Job
Applicant
Mother/Father 1
Mother/Father 2
Sibling
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Does the applicant have any siblings that are attending SASUC’s Nursery or Kindergarten? Yes
No
If so, who? ____________________________________________________________________
D. HOUSEHOLD SOCIO-ECONOMIC DATA
I. Do you choose to pay the maximum tuition fee? Yes
No
(If so, you do not have to provide the information requested in this group. Otherwise, failure to provide this information, along
with its supporting evidence, implies the allocation of the maximum monthly fee, in accordance with paragraph 9 of Article 7 of
the operating rules of SASUC’s Nursery and Kindergarten1)
II. Do you wish to benefit from a reduced monthly fee, adjusted to the socio-economic
situation of the household? (Only applicable to candidates with ties to the UC)
Yes
No
If so, please attach the following documents:
a)
Proof of income:
Previous year’s tax return;
Previous year’s IRS settlement demonstration;
Proof of all income earned by all household members that was not declared for IRS (e.g.:
Research/study grants; social integration allowances; allowances for medical leave of absence;
unemployment allowances; training allowances; etc.)
b) Proof of expense:
Rent receipt or proof of bank loan for own house acquisition;
Supporting evidence for expenditures regarding healthcare, in case of recognized longterm illness.
III. Additional information deemed relevant to the clarification of the household’s socioeconomic status.
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
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"Article 7 Monthly fees - [...] 9 - the maximum monthly payment will be applied whenever there is failure to produce documentary
evidence of income or the produced evidence is insufficient, until the month following that in which it is possible to determine the
appropriate monthly fee".
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E. ADDITTIONAL INFORMATION
Why do you want to enroll the applicant child in SASUC’s Nursery / Kindergarten?
______________________________________________________________________________
______________________________________________________________________________
How did you learn of this service?
______________________________________________________________________________
______________________________________________________________________________
Other relevant information:
______________________________________________________________________________
______________________________________________________________________________
To complete the application, attach copies of the following documents:
Guardian’s Citizen/ Identification Card/ Passport (mandatory);
Child's Citizen/Identification Card/ Passport/ Birth certificate (mandatory);
Proof of child’s Taxpayer Identification Number (required, whenever the Child has no Citizen Card);
Proof of registration at the UC (required whenever under section B you declare to be a UC student.);
Proof of UC staff membership (required whenever under section B you declare to be UC staff member);
Proof of income (optional whenever you choose to pay maximum fee);
Proof of expense (optional whenever you choose to pay maximum fee);
Residence permit statement in the case of foreign applicants;
Certificate stating scholarship amount in the case of scholarship students, except for SASUC scholarship
holders.
Note: After validation of the application, during the Child's registration phase at the Childcare, you will be asked to
produce a copy of Child’s vaccination Card and medical bill of health.
Date: dd / mm / yyyy
Guardian’s signature
________________________________
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