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Westchester Community College, State University of New York

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Virginia Marx Children’s Center Application Form for Enrollment

About Your Child

Child's Name *
Date of Birth
Home Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

About You

Parent's Name *
Home Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone (Home)
Email
Occupation
Employer's Name
Employer's Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone (Work)
Phone (Cell)
Parent's Name (2)
Home Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone (Home)
Email
Occupation
Employer's Name
Employer's Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Phone (Work)
Phone (Cell)

Are You

Westchester Community College
Full-Time StudentPart-Time StudentStaffFaculty
If you are staff or faculty, please provide us with your department and your extension
If you are a student, please provide your Student ID
Hours Requested
Full-TimePart-Time (Student parent - minimum of 20 hours required per week)

Or A

Community Parent
Community Parent Full-TimeCommunity Parent Part-Time
Days Requested
MondayTuesdayWednesdayThursdayFriday
Note A non-refundable registration fee is charged for the enrollment of each child: $75.00 for children of WCC staff, WCC faculty, County Employees & Community Parents $30.00 for children of WCC student-parents

Verification

Please enter any two digits with no spaces (Example: 12) *
This box is for spam protection - please leave it blank

Student Services

Associate Dean of Student Life
- Important Student Forms
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- Request to Return from Involuntary Withdrawal
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- General Information
- Hours of Operation
- Viking Dining Dollars
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  - Immunization Form
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  - Emergency Aid Application
Title IX
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- Veterans Checklist
- Financing your Education

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Westchester Community College, State University of New York

Building Minds. Building Futures.

Westchester Community College provides
accessible, high quality and affordable education
to meet the needs of our diverse community.
We are committed to student success, academic
excellence, workforce development, economic
development and lifelong learning.

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75 Grasslands Road
Valhalla, NY 10595
Tel: (914) 606-6600

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