RSCCD CHILD DEVELOPMENT SERVICES
Santa Ana College Early
Childhood Education Center
(714) 564-6894
Santa Ana College
East Campus
(714) 564-6952
Centennial
Education Center
(714) 241-5739
Santiago Canyon
College Center
(714) 628-4890
Orange
Education Center
(714) 628-5925
ELIGIBILITY APPLICATION “WHAT HAPPENS NEXT”
Thank you for considering our center for your child care needs. Your family will be placed
on the eligibility/wait list and ranked according to your gross family income and your
family size. (Please see attached Reference Sheets A, B and C.)

Eligibility is based on documentation and verification of at least one of the following:
Income
Homelessness
At Risk of Abuse/Neglect and/or Exploitation


Priority for selection are: Child Protective Services; At Risk of Abuse/Neglect and/or
Exploitation; Lowest rank (if two or more families have the same rank and child’s birth
date, the oldest dated application is placed first)
The need for full day child care services is based on documentation and verification of at
least one of the following (See attached Reference Sheet A and B):
Child Protective Services
Parental Incapacity
Employment



Current Aid Recipient
Child Protective Services
At Risk of Abuse/Neglect and/or Exploitation
Training toward Vocational Goal
The waiting period for services is unpredictable and a definite timeframe for your child or
children’s admission into the program may not be known.
Although we may have openings throughout the school year, most of our enrollment
occurs during each summer and fall.
Once space becomes available here at the center, you will be called and a pre-enrollment
appointment will be scheduled. You will be asked to bring the following documentation:
1. The family’s “total countable income” for the previous month (see attached Reference Sheet C)
2. Verification of your eligibility and need (see attached Reference Sheet A and B)
Once eligibility and need is verified, you will be given a registration packet to be
completed and given an appointment for registration. At the registration
appointment, you will be asked to complete the Application for Services and be
issued a Notice of Action (NOA) certifying your child’s first day of service.


Please feel free to call us to check your status and/or to let us know if you have found
other services.
During this waiting period, you are encouraged to contact the local resource and referral
agency, Children’s Home Society. They also have funding to assist families. They can be
reached at 714 543.2273.
Thank you again for your interest in our program
We look forward to serving you in the future
RSCCD CHILD DEVELOPMENT SERVICES
Reference Sheet A
Eligibility and Need Criteria
Child Protective Services - Written referral dated within six months of application for services that
includes:
 A statement from the local county welfare department, child welfare services worker, certifying
that the child is receiving Child Protective Services (CPS) and that child care and development
service are a necessary component of the CPS service plan.
 Probable duration of the CPS service plan.
 Name, address, phone number and signature of the county child welfare staff.
“At Risk” - Written referral dated within six months of the application for services, including:
 A statement by a legally qualified professional (someone licensed in the state to perform legal,
medical, health or social services for the general public) that the child is at risk of abuse and
neglect and that the child and development services are needed to reduce or eliminate that risk.
 Probable duration of the at risk situation.
 Name, address, phone number and signature of the legally qualified professional.
Parental Incapacity – Proof of parental incapacitation must include:
 A signed release statement authorizing a legally qualified health professional to disclose
information necessary to establish that the definition of incapacity is met and
 A statement from a legally qualified health professional that includes the following:
- that the parent is incapacitated and incapable of providing care and supervision for the child for
part of the day and,
- the extent to which the parent is incapable of providing care and supervision.
- the days and hours per week that services are recommended.
- the probable duration of incapacitation.
- name, business address, telephone number, professional license number, and signature of the
health professional.
Employment – A completed “employment verification form” verifying work hours is required.
Training towards Vocational Goal – A completed “training verification form” and class registration
printout is required for each semester.
We reserve the right to ask for additional documentation.
Rancho Santiago Community College District
Child Development Services
REFERENCE SHEET B
FAMILY SIZE VERIFICATION
Required documents for the number of children (siblings) in family
Title 5: Subchapter 3, Article 3 – 18100 (a)(1)
The following list of documents can be used to support the number of children in a family:
(at least one document from this list must be provided)
(A) Birth certificate;
(B) Court orders regarding child custody;
(C) Adoption documents;
(D) Records of Foster Care Placements;
(E) School or medical records;
(F) County welfare department records;
(G) Other reliable documentation indicating the relationship of the child to the parent;
(H) Baptismal Certificate;
(I) Hospital Birth Record;
(J) Passport;
(K) Declaration of home birth.
Required documents regarding the presence or absence of the second parent
Title 5: Subchapter 3, Article 3 – 18100 (a)(2)
The following list of documents can be used to support the presence or absence of the second parent
(when only one parent is enrolling the child and/or the documentation for the child/ren indicates that there
is another parent whose name does not appear on the application):
(any one document from this list must be provided)
(A) Records of marriage, divorce, domestic partnership or legal separation;
(B) Court-ordered child custody arrangements;
(C) Evidence that the parent signing the application is receiving child support payments from that
person, has filed for child support with the appropriate local agency, or has executed
documents with that agency declining to file for child support;
(D) Rental receipts or agreements, contracts, utility bills or other documents for the residence of
the family indicating that the parent is the responsible party;
(E) Death certificate;
(F) Notarized letter verifying that the absent parent is out of the country;
(G) Income Tax filing listing parent signing the application as Head of Household;
(H) Incarceration documents;
(I) Deportation documents;
(J) Any other documentation to confirm the presence or absence of a parent of a child in the
family.
The enrolling parent may use a self-declaration to explain the absence of the parent from the family if,
due to the recent departure of a parent from the family, the remaining parent cannot provide any
documentation. The self-declaration must be signed by the enrolling parent under penalty of perjury and
the enrolling parent must provide documentation regarding the absent parent within six (6) months of
signing the self-declaration.
Title 5: Subchapter 3, Article 3 – 18100 (a)(3)
We reserve the right to ask for additional documentation.
RSCCD CHILD DEVELOPMENT SERVICES
Reference Sheet C
Total Countable Income
(per Title 5 Education Code)
Total Countable Income means ALL income of the individuals counted in the family
size and is for the month preceding certification or re-certification, for example:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
Gross Wages or Salaries (including overtime and tips)
Public Cash Assistance / Aid
Gross Income from Self-Employment (minus business expenses, except
wage draws)
Disability or Unemployment Compensation
Workers Compensation
Spousal Support
Child Support Payments Received * +
Survivor Benefits
Retirement Benefits
Dividends, interest on bonds, income from estates or trust, net rental income
or royalties
Rent for Room within the Family’s Residence
Foster Care Grants (payments or clothing allowance for children placed
through child welfare services)
Financial Aid Received for the Care of a Child Living with an Adult Who is
not the Child’s Biological or Adoptive Parent
Veterans pensions
Pensions or Annuities
Inheritance
Allowances for Housing
Portion of Student Grants/Scholarships not identified for educational
purposes as tuition, books or supplies
Insurance or Court Settlements for Lost Wages or Punitive Damages
Net Proceeds from the Sale of Real Property, Stocks, or Inherited Property
Other Enterprise for Gain
* May include child support received from the former spouse or absent parent, or financial assistance for
housing cost or car payments paid as part of, or in addition to, spousal or child support.
+ Evidence must be provided that the parent signing the application:
a.
is receiving child support payments from that person
b.
has filed for child support with the appropriate local agency, or
c.
has executed documents with that agency declining to file for child support.
(Title 5 Education Code Reference 18078 (q),(1-28)
We reserve the right to ask for additional documentation to verify income.
Adopted 7/15/08 / Revised 5/24/12 / Revised 9/19/12
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Happens Next