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I am a Parent

Centralized Eligibility List Application

The Centralized Eligibility List (CEL) is access to free or low cost child care and preschool programs in Santa Clara County.

The 4C Council operates a countywide list of income-eligible families that need child care financial assistance. This is a free service that connects families to over 170 child care locations that receive funding from the California Department of Education to help low-to moderate-income families in their area.

For more information about CEL, click here.

To add your name to CEL, print out and complete a CEL application in the language of your choice, then send it to 4Cs at:

Communicty Child Care Council of Santa Clara County
2515 N. First St.
San Jose, CA 95131

When your application has been received, you will be contacted by a CEL representative. Applicants should update their status on CEL every three months by calling 877-235-0095. Due to the high demand for subsidized child care in Santa Clara county, there is no guarantee that everyone who applies will receive assistance.

Or, instead of printing and mailing your application, you may fill out the CEL application questions below and submit them online.

Primary Parent
Relationship to Child:
Parent
Grandparent
Foster Parent
Legal Guardian
Other:
Primary Parent Name:
Preferred Zip Codes - 1:
2:
3:
Current Address:
Apartment/Unit:
County:
City:
State:
Zip Code:
Home Phone:
Cell:
Work:
Email:
Language:
Ethnicity:
Family Size (include parents & children):
 
Date of Birth:
Secondary Parent
Living in the home?:
Yes
No
Secondary Parent Name:
Email:
Date of Birth:
Cell:
Work:
Language:
Ethnicity:
Family Information
Characteristics (check all that apply):
 
Child Protective Services
Teen Parent
Seasonal Migrant Worker
Other:
Marital Status:
Single
Married
Separated
Divorced
Widowed
Housing (check all that apply):
 
Currently homeless
Living in a shelter
None
Are you a Community College or University student?:
 
Yes
No
If yes, name of school:
Reason for Care
Primary Parent:
Working
Attending School/Training
Looking for Work
Medically Incapacitated
Part-Time Preschool (3 hours)
If working, work zip code:
If attending school, school zip code:
 
 
Secondary Parent:
Working
Attending School/Training
Looking for Work
Medically Incapacitated
Part-Time Preschool (3 hours)
If working, work zip code:
If attending school, school zip code:
 
Living in the home?:
Yes
No
Monthly Income: Primary Parent
Total Monthly Wage:
Paid:
Monthly
Bi-weekly
Weekly
Hours & Wage
Hours per week:
$ per hour:
Child Support:
Spousal Support:
Cash Aid or Foster Payment:
 
State Disability Insurance (SDI):
 
Supplemental Security Income (SSI):
 
Other Income (Type):
Amount:
Monthly Income: Secondary Parent
Living in the home?:
Yes
No
Total Monthly Wage:
Paid:
Monthly
Bi-weekly
Weekly
Hours & Wage
Hours per week:
$ per hour:
Child Support:
Spousal Support:
Cash Aid or Foster Payment:
 
State Disability Insurance (SDI):
 
Supplemental Security Income (SSI):
 
Other Income (Type):
Amount:
Eligibility Assessment
Are you currently receiving child care/preschool assistance for your child(ren)?:
 
Yes
No
If yes, name of program:
Have you received Cash Aid (Welfare/TANF/AFDC) within the last 2 years?:
 
Yes
No
If yes, date last received:
 
If yes, provide your Case Number:
 
Are you currently participating in CalWORKs?:
 
Yes
No
Child 1
Name:
School:
School District:
Date of Birth:
Special Needs?:
Yes
No
If yes:
IEP
IFSP
Please explain:
Schedule of Care:
(F/T) Full time
(P/T) Part time
Evening
Weekend
Variable
Overnight
Preferred Child Care Center/Preschool:
 
Program:
Preferred type of child care setting/arrangement:
 
Center
Licensed Family Home
Relative/Friend
Currently Enrolled?:
Yes
No
If yes, what program:
Reason for re-applying:
Child 2
Name:
School:
School District:
Date of Birth:
Special Needs?:
Yes
No
If yes:
IEP
IFSP
Please explain:
Schedule of Care:
(F/T) Full time
(P/T) Part time
Evening
Weekend
Variable
Overnight
Preferred Child Care Center/Preschool:
 
Program:
Preferred type of child care setting/arrangement:
 
Center
Licensed Family Home
Relative/Friend
Currently Enrolled?:
Yes
No
If yes, what program:
Reason for re-applying:
Child 3
Name:
School:
School District:
Date of Birth:
Special Needs?:
Yes
No
If yes:
IEP
IFSP
Please explain:
Schedule of Care:
(F/T) Full time
(P/T) Part time
Evening
Weekend
Variable
Overnight
Preferred Child Care Center/Preschool:
 
Program:
Preferred type of child care setting/arrangement:
 
Center
Licensed Family Home
Relative/Friend
Currently Enrolled?:
Yes
No
If yes, what program:
Reason for re-applying:
Child 4
Name:
School:
School District:
Date of Birth:
Special Needs?:
Yes
No
If yes:
IEP
IFSP
Please explain:
Schedule of Care:
(F/T) Full time
(P/T) Part time
Evening
Weekend
Variable
Overnight
Preferred Child Care Center/Preschool:
 
Program:
Preferred type of child care setting/arrangement:
 
Center
Licensed Family Home
Relative/Friend
Currently Enrolled?:
Yes
No
If yes, what program:
Reason for re-applying:
List children that DO NOT need care
Name:
Date of Birth:
If already enrolled, program:
 
 
Name:
Date of Birth:
If already enrolled, program:
 
 
Name:
Date of Birth:
If already enrolled, program:
 
Application Consent
By checking the box below you acknowledge and grant permission for your application to be shared among participating agencies.

- I declare that the above information is complete and true to the best of my knowledge.

- I understand my eligibility is based upon information given here and that documentation will be required prior to enrollment.

- In order to remain active on the CEL, I must take immediate action to inform 4Cs of any changes to my address, phone number or income.

- This application is valid for 3 months, however I understand that if I do not update this application within 3 months, my name will be removed
from the list.
Do you accept?:
I accept
Questions? Call (877) 235-0095
 
 
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