Are you Interested in ECACE? | Joliet Junior College

First Name

Last Name

Phone

Address

City

State

Zip Code

Have you previously or are you currently working in the Child Care/Early Childhood (Birth-5yr) field?

Yes

Please provide your Gateways Registry Number

To register: Illinois Gateways to Opportunity Registry (ilgateways.com)

Have you completed the ECACE scholarship application

Yes

Not Eligible

Have you applied to JJC or previously attended?

Yes

Please Provide Your JJC Student ID Number

Program Name/Major

Credit Hours Earned

Do you have any college experience?

Yes

Have you received any of the following CDEV Certificates or degrees from JJC?

Child development Certificate of Completion SS052

Enter Date Received

Child Development Certificate of Achievement SS055

Enter Date Received

Infant Toddler & Two's Educator Certificate of Achievement SS053

Enter Date Received

CDA - Child Development Associates

Enter Date Received

Other Education Degrees/Credentials

When are you looking to attend/enroll in school?

Additional Questions

This form is only for individuals living or working within the JJC district boundaries.

The project described was supported by the Preschool Development Grant Birth through Five Initiative (PDG B-5), Grant Number 90TP0001-01-00, from the Office of Child Care, Administration for Children and Families, U.S. Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Office of Child Care, the Administration for Children and Families, or the U.S. Department of Health and Human Services.

By submitting this form, I agree to my provided details being used for the purposes of recruitment, enrollment, or other engagements with JJC as indicated on this form. The information will only be accessed by college staff on a need to know basis, in accordance with federal, state and local laws. I understand my data will be held securely and will not be distributed to third parties for commercial purposes, unless required by state or federal law. I have a right to change or access my information, as well as limit disclosures in accordance with the Family Educational Rights and Privacy Act (FERPA). Please see Website Privacy Procedure 10.01.02.01 (available upon request from compliance@jjc.edu) for further information.

CAPTCHA