CYC Enrollment Application

Please complete the application below.

**$25 NON-REFUNDABLE FILING FEE MUST BE PAID BEFORE APPLICATION SUBMISSION!**

Note: ALL programs are currently open for waitlist applications for enrollment.

First Parent/Guardian Information
Parent/Guardian's Last Name
Parent/Guardian's First Name
Parent/Guardian's Email
Parent/Guardian's Affiliation with IUPUI:

Parent/Guardian's Affiliation with IUPUI: IU Affiliation IU Health Employee Community
Parent's Employer:
Parent/Guardian's IU Employee/Student affiliation:

Parent/Guardian's IU Employee/Student affiliation: Faculty Staff Student
Department:
Parent/Guardian's Affiliate Employer:

Parent/Guardian's Affiliate Employer: IU Health
Parent/Guardian's Address Parent/Guardian's Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Home Phone - ### - ### ####
Cell Phone Cell Phone - ### - ### ####
Work Phone Work Phone - ### - ### ####

CYC Enrollment Application

CYC Enrollment Application

First Parent/Guardian Information