child care resource and referral customer cover...

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Child Care Resource and Referral Customer Cover Letter Dear Parents, Thank you for contacting Child Care Resource and Referral. It is our goal to assist you in locating a quality child care program that meets your family’s needs. Choosing an early care and education provider is one of the most important decisions that families make. It is important to choose a provider who meets the needs of your child and with whom you feel comfortable. Enclosed are the child care referrals that you requested as well as some additional information that may help you in the child care selection process. Please note that these referrals were computer generated using the selection criteria that you provided and we do not license, endorse, or recommend any particular provider. Each family’s situation and each child are unique; therefore, only you can best determine which program is right for you and your child. Currently, we serve Hillsborough County; services are provided at no cost. Our hours of operation are 8:00 a.m. to 4:45 p.m., Monday through Friday. Our database includes all legally operating providers (those that have met all state and local licensing or registration requirements). It is essential that you make at least one unannounced visit before making your child care selection. We also recommend you contact the Hillsborough County’s licensing office (listed below) to review provider files prior to making a child care selection for your child(ren). Here are some resources that may be of interest to you: Review Provider License Files—contact Hillsborough County Child Care Licensing, 3152 Clay Mangum Lane, Tampa, FL, 33618 or access their licensing web page: http://www.myflorida.com/childcare Quality Check List for Evaluating Early Learning Programs and A Family Guide for Selecting Quality Early Learning Programs at http://www.sdhc.k12.fl.us/doc/list/childcareresourceandreferral/documentsforms/151701/ Quality Counts for Kids at www.elchc.org or 8132800800 Voluntary Prekindergarten and Readiness Rate Information: http://www.fldoe.org/earlylearning Florida’s Office of Early Learning Call Center: http://www.floridaearlylearning.com or 18663573239 Child Abuse Registry contact information: https://reportabuse.dcf.state.fl.us or 18009622873 Central Directory of Early Childhood Services (providing services to children with special needs): 18006544440 or you can access their web page: http://www.centraldirectory.org Florida Diagnostic & Learning Resources System/Child Find: http://fdlrs.mysdhc.org/ or 8138377777 Florida KidCare (health insurance program): http://www.floridakidcare.org or 18885405437 211 Information & Referral and Crisis Counseling: www.211atyourfingertips.org or 211 Please be aware that programs with a Gold Seal designation have demonstrated a commitment to providing a high quality program for young children and their families. If you need additional child care referrals, community services/information, or would like information about Voluntary Prekindergarten or School Readiness programs, please feel free to contact us at 8137448942. You can also request a list of providers online by visiting our Child Care Resource and Referral website for parents at www.elchc.org . If you would like to send a comment or concern to Shawntaye Beato, Program Manager, about the services you received, please call 8137448941 ext. 232. Sincerely, Shawntaye Beato – Program Manager, 8137448941, ext. 232 If you are dissatisfied with the Child Care Resource and Referral services, you have the right to submit disputes and/or disagreements regarding these services to the Early Learning Coalition of Hillsborough County at 8135152340. For a complete copy of this policy, please contact the Early Learning Coalition. FUNDED BY THE EARLY LEARNING COALITION OF HILLSBOROUGH COUNTY 6800 N. Dale Mabry Hwy, Suite 158, Tampa, FL 33614 (813) 515-2340 Web Site: www.elchc.org EARLYCHILDHOOD AND H.O.S.T. PROGRAMS 5701 East Hillsborough Avenue, Suite 2301, Tampa, FL 33610 (813) 744-8941 FAX: (813)744-8954 Web Site: www.sdhc.k12.fl.us/departments/47/early-childhood/about/

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Page 1: Child Care Resource and Referral Customer Cover Letterearlychildhood.mysdhc.org/documents/CCRR-parentpac… ·  · 2014-12-08Child Care Resource and Referral Customer Cover Letter

Child Care Resource and Referral Customer Cover Letter 

     

 

Dear Parents,  

Thank you  for contacting Child Care Resource and Referral.    It  is our goal  to assist you  in  locating a quality child care program that meets your family’s needs.   Choosing an early care and education provider  is one of the most  important decisions that families make. It is important to choose a provider who meets the needs of your child and with whom you feel comfortable. Enclosed are the child care referrals that you requested as well as some additional  information that may help you  in the child care selection process.   Please note that these referrals were computer generated using the selection  criteria  that  you  provided  and we  do  not  license,  endorse,  or  recommend  any  particular  provider.  Each family’s situation and each child are unique; therefore, only you can best determine which program is right for you and your child.    

Currently, we serve Hillsborough County; services are provided at no cost.  Our hours of operation are 8:00 a.m. to 4:45 p.m., Monday through Friday. Our database includes all legally operating providers (those that have met all state and local licensing or registration requirements). It is essential that you make at least one unannounced visit before making your child care selection.  We also recommend you contact the Hillsborough County’s licensing office (listed below) to review provider files prior to making a child care selection for your child(ren).   

Here are some resources that may be of interest to you:  

Review Provider License Files—contact Hillsborough County Child Care Licensing, 3152 Clay Mangum Lane, Tampa, FL, 33618 or access their licensing web page: http://www.myflorida.com/childcare 

Quality Check List for Evaluating Early Learning Programs and A Family Guide for Selecting Quality Early Learning Programs at http://www.sdhc.k12.fl.us/doc/list/child‐care‐resource‐and‐referral/documents‐forms/151‐701/ 

Quality Counts for Kids at www.elchc.org or 813‐280‐0800 

Voluntary Prekindergarten and Readiness Rate Information:  http://www.fldoe.org/earlylearning  

Florida’s Office of Early Learning Call Center:  http://www.floridaearlylearning.com or 1‐866‐357‐3239    

Child Abuse Registry contact information: https://reportabuse.dcf.state.fl.us or 1‐800‐962‐2873 

Central Directory of Early Childhood Services (providing services to children with special needs): 1‐800‐654‐4440 or you can access their web page: http://www.centraldirectory.org   

Florida Diagnostic & Learning Resources System/Child Find: http://fdlrs.mysdhc.org/ or 813‐837‐7777   

Florida KidCare (health insurance program):  http://www.floridakidcare.org  or 1‐888‐540‐5437 

2‐1‐1 Information & Referral and Crisis Counseling: www.211atyourfingertips.org or 211  

Please be  aware  that programs with  a Gold  Seal designation have demonstrated  a  commitment  to providing  a high quality  program  for  young  children  and  their  families.    If  you  need  additional  child  care  referrals,  community services/information, or would like information about Voluntary Prekindergarten or School Readiness programs, please feel  free  to  contact  us  at  813‐744‐8942.    You  can  also  request  a  list  of  providers  online  by  visiting  our  Child  Care Resource and Referral website for parents at www.elchc.org.  

If  you  would  like  to  send  a  comment  or  concern  to  Shawntaye  Beato,  Program Manager,  about  the  services  you received, please call 813‐744‐8941 ext. 232.  

Sincerely,   Shawntaye Beato – Program Manager, 813‐744‐8941, ext. 232   

If you are dissatisfied with the Child Care Resource and Referral services, you have the right to submit disputes and/or disagreements  regarding  these services  to  the Early Learning Coalition of Hillsborough County at 813‐515‐2340. For a complete copy of this policy, please contact the Early Learning Coalition.  

 FUNDED BY THE EARLY LEARNING COALITION OF HILLSBOROUGH COUNTY 6800 N. Dale Mabry Hwy, Suite 158, Tampa, FL 33614 (813) 515-2340 Web Site: www.elchc.org

EARLYCHILDHOOD AND H.O.S.T. PROGRAMS 5701 East Hillsborough Avenue, Suite 2301, Tampa, FL 33610

(813) 744-8941 FAX: (813)744-8954 Web Site: www.sdhc.k12.fl.us/departments/47/early-childhood/about/

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OBSERVATION TIPS

Visit Florida’s Office of Early Learning at www.FloridaEarlyLearning.com or call (Toll Free) 866-357-3239 (TTY/TTD: 711)

FLORIDA DEPARTMENT OF EDUCATION JULY 2013

Making an informed decision. Your first concerns are your child’s safety, health and welfare. Every program will have positive features, but only you can decide what is most important.

Looking and listening. You can tell a great deal by watching and listening to what is going on in a classroom or home. Do the children seem to be happy and enjoying their activities? Do the teachers seem loving, nurturing and responsive to all children in their care? Are problems handled promptly and appropriately? Do the teachers seem like people you can trust with your child’s health, happiness and well¬being? Is this a place where you would feel good about your child spending many hours each day?

Asking questions. If you have any questions or concerns, write them down as they occur to you. Ask for a time to discuss them with the teacher or director.

Paying attention to your instincts. You know your child best. Pay attention to any uneasy feelings you may have had during your visit. Can you picture your child in this setting? Were the toys and activities you observed the kinds your child would enjoy? Were they clean? If your child was with you, what was his reaction? Children respond in their own unique ways to new situations. Don’t rule out other factors that could influence your child’s reaction such as being hungry or tired. Trust your instincts and your ability to make wise decisions for your child.

Considering costs. Carefully weigh the “pros” and “cons” of each teacher and facility that you visited. Decide which one meets the greatest number of your priorities at a rate you can afford. Keep in mind that the highest cost doesn’t guarantee the best teacher and facility. Likewise, the least expensive rates do not necessarily mean poor teachers and facilities.

Making a good choice. Now that you have done your homework and some careful thinking, you are ready to make your choice. Remember, selecting and placing your child in an early learning program is just the beginning. Talk to the new teacher often and visit occasionally to ensure your child is safe and happy and your decision was the right one.

A Quality Checklist For Evaluating Early Learning Programs

Page 3: Child Care Resource and Referral Customer Cover Letterearlychildhood.mysdhc.org/documents/CCRR-parentpac… ·  · 2014-12-08Child Care Resource and Referral Customer Cover Letter

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Page 4: Child Care Resource and Referral Customer Cover Letterearlychildhood.mysdhc.org/documents/CCRR-parentpac… ·  · 2014-12-08Child Care Resource and Referral Customer Cover Letter

Community Resource Guide

Interpreters available for 150 Languages

Suicidal Callers................................................1-800-273-TALK(8255) Poison Information Center.........................................................1-800-222-1222 ABANDONED BABY PROGRAM For Help or Information Call........................................................................2-1-1 ABUSE - CHILD & ADULT Abuse Reporting Hotline..........................................................1-800-96-ABUSE Champions for Children........................................................................673-4646 Child Protection Team..........................................................................250-6670 Hillsborough Kids, Inc. .........................................................................225-1105 Joshua House.......................................................................................263-3469 The Spring of Tampa Bay.....................................................................247-7233 ADDICTION & SUBSTANCE ABUSE ACTS....................................................................................................367-2315 Al-Anon / Alateen..................................................................................881-9372 Alcoholics Anonymous (24hrs).............................................................933-9123 The Centre…….....................................................................................251-8437 DACCO.................................................................................................984-1818 Florida Substance Abuse Hotline...............................................1-800-662-4357 Narcotics Anonymous...........................................................................879-4357 Operation PAR...........................................................................1-888-727-6398 Phoenix Houses of Florida – Teen & Adult Outpatient………………....881-1000 Salvation Army Adult Rehabilitation Center..........................................972-0471 Tampa Crossroads (Offender Services)...............................................238-8557 Turning Point of Tampa..............................................................1-800-397-3006 Windmoor Healthcare.................................................................1-888-834-2946 CHILD CARE & YOUTH SERVICES INFORMATION *Child Development Infoline………………………813-425-GROW(4769) Big Brothers & Big Sisters.....................................................................769-3600 SEEDS……………………………...........................................................901-3442 Early Childhood Council.……………………………………….................837-7753 Boys & Girls Club..................................................................................875-5771 Child Care Resource & Referral ………................................................744-8942 REACHUP……......................................................................................712-6315 CINS/FINS…………………....................................................................264-3807 Healthy Start..........................................................................................307-8016 Hills. County Child & Family Counseling ext. 136…………………....….264-3807 Hillsborough County Head Start/Early Head Start.................................272-5140 Hillsborough County Parks & Recreation...............................................635-3500 Hillsborough County Public Schools Head Start....................................744-8941 FDLRS………………………………………………………………….….....837-7777 PACE Center for Girls............................................................................739-0410 Phone-Friend - Reassurance & Homework Help…………………..….681-6543 Voluntary Pre-Kindergarten…………………………………………….…..204-1727 Youth Advocate Programs………………………………………….…..…..248-3980 YMCA…………………………………………………………………………224-9622

COUNSELING & MENTAL HEALTH Adult Emergency Services..............................................................272-2958 Camelot Community Mental Health….………………………..……..635-9765 Catholic Charities............................................................................631-4370 Children’s Crisis Center..................................................................272-2882 Life Center of the Suncoast............................................................237-3114 Northside Mental Health Center......................................................977-8700 Tampa Jewish Family Services.......................................................960-1848 Tampa Veteran’s Center.................................................................238-8557 EDUCATION Adult & Community Education.........................................................740-7750 Hillsborough Community College....................................................253-7000 Hillsborough County Public Schools……........................................272-4000 Hispanic Services Council...............................................................936-7700 Public Library Cooperative…………………………………………….273-3652 EMPLOYMENT AARP Senior Community Service Employment Program...............962-4600 The Centre……… ...........................................................................251-8437 Career Resource Center- CDC of Tampa..........................231-4362 ext. 301 City of Tampa Employment Services..............................................274-8911 Employment Opportunity Program ………......................................272-5040 Goodwill Industries...................................................................727-523-1512 Hillsborough Civil Service Job News Line Recordings…………......272-6975 Vocational Rehabilitation.................................................................233-3600 Tampa Bay Workforce Alliance.......................................................930-7400 FINANCIAL ASSISTANCE ACCESS Florida Information Line/DCF................................1-866-762-2237 Lee Davis Neighborhood Service Center........................................272-5220 Plant City Neighborhood Service Center.........................................757-3871 SouthShore Community Resource Center......................................671-7647 University Area Neighborhood Service Center................................975-2153 West Tampa Neighborhood Service Center....................................272-5074 Salvation Army Family Services Program ext. 300.........................226-0055 Social Security Administration ..............................................1-800-772-1213 Women, Infants, & Children - WIC..................................................307-8074 FIRE DEPARTMENTS Hillsborough County Fire Department.............................................272-6600 Plant City Fire Department..............................................................757-9199 Tampa Fire Department ..................................................................274-7011 Temple Terrace Fire Department....................................................506-6700 FOOD Community Food Bank....................................................................960-1848 Cook’s Hat.......................................................................................236-6237 ECHO Emergency Care Help- Brandon..........................................685-0935 Food Stamps.........................................................................1-866-762-2237 Meals on Wheels -Tampa................................................................238-8410 Meals on Wheels - Plant City...........................................................754-9932 Metropolitan Ministries - Outreach & Prevention.............................209-1044 United Food Bank & Services of Plant City.....................................764-0625

Search our community resources online at: www.211atyourfingertips.org

Service providers add or update your program information here.

CRISIS CENTER OF TAMPA BAY SERVICES • 2-1-1 Tampa Bay – Information & Referral and Crisis Counseling – 2-1-1; TTY 969-4944 • Child Development Infoline –813-425-GROW(4769) • Corbett Trauma Center – Trauma Counseling Services for Children & Adults –264-9955 • Telephone Reassurance – Daily Reassurance & Safety Checks – 964-1577; TTY 969-4992 • Family Stabilization– Financial Assistance – 264-9949 • Sexual Assault Services – Sexual Assault Forensic Medical Unit – 2-1-1 • TransCare – Emergency Medical and/or Mental Health Transportation - 681-4422 • Volunteer Services - 969-4991

Get Connected. Get Answers.Crisis Center of Tampa Bay

Tampa Bay

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HOMELESS / TRANSITIONAL SERVICES Abe Brown Ministries....................................................................247-3285 Alpha House.................................................................................875-2024 Homeless Recovery Program.......................................................276-2976 Homeless Veterans Program........................................................979-3563 Mary & Martha House (Women & Children).................................641-7027 Metropolitan Ministries..................................................................209-1200 River of Grace Ministries (Men)....................................................374-9013 Salvation Army Hope House - Men’s Transitional ext. 264................................226-0055 Hospitality House - Women & Children ext. 297.......................226-0055 Red Shield Lodge - Men & Women ………...............................221-4440 HOUSING / HOUSING COUNSELING City of Tampa Department of Code Enforcement.........................274-5545 Consumer Credit Counseling Services...............................1-800-251-2227 Hillsborough County Dept. of Code Enforcement.........................274-6600 Housing Authority of the City of Tampa........................................253-0551 Volunteers of America...................................................................282-1525 www.FloridaHousingSearch.org ........................................1-877-428-8844 LAW ENFORCEMENT Florida Highway Patrol..................................................................632-6859 Hillsborough County Sheriff’s Office..............................................247-8200 Plant City Police Department.........................................................757-9200 Tampa Police Department ............................................................231-6130 Temple Terrace Police Department ...............................................989-7111 University of South Florida Police..................................................974-2628 LEGAL ASSISTANCE Bay Area Legal Services................................................................232-1343 Baker Act / Marchman Act – Courthouse.......................................276-8100 Children’s Justice Center...............................................................272-7179 Child Support Enforcement..................................................1-800-622-5437 Consumer Protection & Professional Responsibility Agency.................................................................903-3430 Guardian Ad Litem ..........................................................................272-5110 Hillsborough County Victim’s Assistance.......................................272-6472 Lawyer Referral Service .................................................................221-7780 Mediation & Diversion Services......................................................272-5642 Public Defender..............................................................................272-5980 State Attorney's Office ...................................................................272-5400 MEDICAL & DENTAL SERVICES All Children’s Hospital...............................................................727-898-7451 Brandon Outreach Clinic..................................................................654-1388 Children’s Medical Services.............................................................396-9743 Consult - A – Nurse...............................................................1-800-257-0944 Dover Health Center........................................................................349-7700 Florida KidCare.........................................................................863-660-3047 Healthcare for Homeless Veterans..................................................979-3563 Hillsborough County Health Department ........................................307-8000 Joyce Ely Health Center..............................................................307-8056 Floyd Kelton Health Center..........................................................307-8055 North Hillsborough Health Center................................................307-8053 Plant City Health Center...............................................................307-8057 Sulphur Springs Health Center…………………………….…….....307-8054 University Area Community Health Center..................................307-8058 Hillsborough Healthcare...................................................................272-5040 James A. Haley Veteran’s Hospital.................................................972-2000 Judeo Christian Health Clinic...........................................................870-0395 LifePath Hospice..............................................................................877-2200 Medicaid Area 6 Field Office............................................................350-4800 Moffitt Cancer Center.......................................................................745-4673 MomCare Hillsborough....................................................................233-2800 Plant City Family Care.....................................................................349-7610 Pregnancy Care Center...................................................................978-9737 Pregnancy Care Center of Plant City...............................................759-0886 Ruskin Health Center.......................................................................349-7800 SunCoast Health Center Pediatrics.................................................341-7450 Shriner’s Hospital for Children.........................................................972-2250 Tampa Family Health Center...........................................................490-1957 West Tampa Health Center.............................................................490-1426

PARENTING SERVICES abcProgram.......................................................................................226-2301 Brandon Family Support & Resource Center....................................740-4634 Central Tampa Family Support & Resource Center..........................204-1741 Fathers Resource & Networking Center - FRANC............................356-1293 Federation of Families for Children’s Mental Health..........................622-7930 North Tampa Family Support & Resource Center.............................558-1877 Parent Resource Center....................................................................272-0673 Parent Services Project/Child Abuse Council....................................673-4646 South County Family Support Resource Center...............................641-5600 Town & Country Family Support & Resource Center ........................356-1703 PERSONS WITH DISABILITIES Service Source of Florida...........................................................727-538-7370 United Cerebral Palsy of Tampa Bay..................................239-1179 ext. 272 Agency for Persons with Disabilities.................................................233-4300 Community Care for Disabled Adults................................................337-5982 Disability Determinations- Department of Health..............................806-8950 Division of Vocational Rehabilitation- Dept. of Education..................233-3600 Florida Division of Blind Services......................................................871-7190 Florida Relay Service- Dial 7-1-1 or .......................................1-800-222-3448 TTY......................................................................................1-800-955-8771 Hillsborough County Health & Social Services..................................272-5040 MacDonald Training Center...............................................................870-1300 Self Reliance .....................................................................................375-3965 TTY................................................................................................375-3972 Tampa Lighthouse for the Blind........................................................251-2407 SENIOR SERVICES United Cerebral Palsy of Tampa Bay- Respite..................................239-1179 Area Agency on Aging Elder Helpline.....................................1-800-963-5337 Alzheimer’s Association ....................................................................684-1296 Community Care for the Elderly........................................................272-5250 Crimes Against the Elderly Unit.........................................................247-0548 Elder Care Locator..................................................................1-800-677-1116 Elder Justice Center..........................................................................276-2726 Life Enrichment Senior Center..........................................................932-0241 Lutheran Services-Guardianship & Case Management.............800-651-1853 Senior Citizens Nutrition & Activities Program - SCNAP...................272-5250 Senior Home Improvement Program - SHIP.....................................232-3200 Serving Health Insurance Needs of Elders- SHINE..........................740-3888 Tampa Jewish Family Services.........................................................960-1848 TRANSPORTATION HARTLINE.........................................................................................254-4278 Sunshine Line....................................................................................272-7272 VOLUNTEER OPPORTUNITIES Retired & Senior Volunteer Program.................................................272-6956 Volunteer Center - United Way of Tampa Bay..................................274-0999 VETERAN & MILITARY SERVICES Office of Veteran’s Affairs………………………………………….……975-2181 Military OneSource……………………………………….……..1-800-342-9647

This publication was underwritten by the Children’s Board of Hillsborough County

*Child Development Infoline is funded by Children’s Board of

Hillsborough County

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School Readiness Programs

WAITING LIST APPLICATIONALL APPLICABLE INFORMATION MUST BE COMPLETED

*SSN is not required for eligibility and services will not be denied due to failure to provide a SSN*Family Information if living in the household- Must be Completed*

Name/Social Security # Date of birthGender

M / F(circle one)

Ethnicity/RaceCircle all that

apply (see boxbelow)

Place of Employment/School

Parent/Guardian

Name_________________________________________________

*SS#_________________________________________________

M or FH / NonH_

W B A H AI

Employer/School:___________________________________

Address:__________________________________________

Work Phone : (________)____________________________

Hourly Wage ___________ # hours worked per week _______

Parent/Guardian

Name_________________________________________________

*SS#_____________________________________________________

M or F H / NonH_W B A H AI

Employer/School:___________________________________

Address:__________________________________________

Work Phone : (________)____________________________

Hourly Wage ___________ # hours worked per week _______

Ethnicity – Hispanic or Non-Hispanic Race – White / Black / Asian / Hawaiian / American Indian

Home Address: _______________________________________________________________________ Apt / Lot # _____________

City:____________________________________________ State:_____________________________ Zip Code:________________

Mailing Address(If Different from Home Address):__________________________________ City/State/Zip Code: _______________________

Home Telephone #: ________________________ Cell telephone #:_________________ Are you receiving SSI? Yes No

Email: _______________________________________________ Language spoken at home: _________________________

Parent/Guardian Marital Status (please check one) Married Single Separated Divorced Widowed

How many people live in your household: # of adults _______ #of children _______

Define relationship of all adults living in household (boyfriend, child over 18, mother-in-law, etc.)______________________________________

List All Children to be Placed on the Waiting List – ALL INFORMATION MUST BE COMPLETED

Child’s Legal Name(first and last name)

Date ofBirth

GenderM / F

Relationshipto child

(see codes below*)

Ethnicity/Racecircle all that

apply

SocialSecurity #

Child’s Current Grade Level(if applicable)

H / NonH_W B A H AI

H / NonH_W B A H AI

H / NonH_W B A H AI

H / NonH_W B A H AI

*Codes: C = Natural/Adopted Child G = Grandchild N = Niece/Nephew F = Foster O = Other

COMPLETE AND MAIL THIS FORM TO: EARLYCHILDHOOD/SCHOOL READINESS PROGRAMS5701 E. HILLSBOROUGH AVENUE, SUITE 2301TAMPA, FLORIDA 33610ATTENTION: SR Waiting List Department

Applications may be faxed to 813.744.6753 or emailed to [email protected]. You will be notified if additional information isneeded prior to placing your child (ren) on the waiting list. You will be contacted by U.S. mail every 6 months to remain on the waiting list.You are required to contact SR to update information as changes occur. When funds are available you will receive an invitation by U.S.mail to come into the office to determine if you are eligible. Invitations are sent based on the established priorities and the date your child(ren) was placed on the waiting list.If you have any questions regarding the waitlist process, please contact SR Waiting List Staff at 813.744.8941 Ext. 532

Families may contact Child Care Resource and Referral at www.elchc.org/ccrr_web_intake.html/ to request a listing ofproviders that may offer scholarships, negotiated rates, or a sliding fee scale rate.

Waiting List Application 10/3/13- rev. 8/1/14