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Child Care Information Request Form

Please complete the form below to request child care information specific to your needs. Your referral information will be emailed within 2 business days. If you would like to speak with someone from our office, please indicate this on the form.

Questions? Call 801-585-5897 or email childcare@sa.utah.edu

General Information
*Indicates required information
  1. *How are you affiliated with the University?
Parent Information
  1. Marital Status
  2. Gender
Child Information
  1. Age(s) (Check all that apply)
  2. Type of care preferred (Check all that apply)
  3. Services required
  4. Area requested for care
Additional Information & Support on Finding Quality Child Care
  1. Please indicate additional information you would like to receive
  2. *Would you like a child care specialist to call you?
  3. *Have you used our
    services before?
Last Updated: 2/8/17