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Child Care Waitlist Application

Please Note: Once you submit your application, you will be directed to a confirmation page to pay the wailist application fee.  You will not be added to the waitlist until you have paid the application fee.

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

Please make sure you complete the waitlist application fee at the end of the application. 

Parent 1 Information














Employer Information for Parent 1







School Information for Parent 1





(YYYY)
Demographic Information for Parent 1


Parent 2 Information (skip if not applicable)














Employer Information for Parent 2 (skip if not applicable)







School Information for Parent 2 (skip if not applicable)





Demographic Information for Parent 2 (skip if not applicable)


Family Information





For reference to the 2022 income guidelines for EHS please see the table at the bottom of this web page.

(MM/DD/YYYY)

Center Preference
Select center(s) in order of preference (ex: First is your most preferred).






Child 1 Information



(MM/DD/YYYY)


Child 2 Information



(MM/DD/YYYY)


Child 3 Information



(MM/DD/YYYY)


Child 4 Information



(MM/DD/YYYY)


Exemption Information

Additional Comments


2023 Poverty Guidlines for the 48 Contiguous States and the District of Columbia

# of Persons in family/household

100%

130%

1

$14,580

$18,954

2

$19,720

$25,636

3

$24,860

$32,318

4

$30,000

$39,000

5

$35,140

$45,682

6

$40,280

$52,364

7

$45,420

$59,046

8

$50,560

$65,728

9

$55,700

$72,410

10

$60,840

$79,092

For families/households within more than 10 persons, add $5,140 for each additional person.
Last Updated: 8/10/23