Rosemount Center Application

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Rosemount Center Application
  1. Please complete all 7 sections of the application to the best of your ability.
    If you are currently pregnant, please indicate the last name of the child and the due date. Note: When the child is born please call the enrollment department at Rosemount Center to update the information.

    Enrollment Options

    Early Head Start (EHS):

    Financial assistance for families who qualify, center-based and home-based program

    DC Department of Human Services assistance (DHS):

    Financial assistance for families who qualify, tuition center-based program

    Tuition:

    Center-based program

    Note: EHS/OSSE applicant must be a DC resident in order to qualify for the program.


  2. Application Date*
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  3. Program Options*

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  4. Age Group*

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  5. Payment Options (check one)*
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  1. Applicant

    (Child Applying for Services)
  2. First Name*
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  3. Middle Name
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  4. Last Name*
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  5. Suffix
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  6. Nickname
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  7. Birthday*
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  8. Gender*

    Invalid Input
  9. Race*
    Invalid Input
  10. Other Race
    Invalid Input
  11. Nationality (Country of Birth)*
    Invalid Input
  12. English Proficiency*
    Invalid Input
  13. Other Language
    Invalid Input
  14. Other Language Proficiency
    Invalid Input
  1. Primary Adult

    (Lives with child)
  2. First Name*
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  3. Middle Name
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  4. Last Name*
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  5. Suffix
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  6. Nickname
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  7. Birthday
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  8. Gender*

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  9. Race*
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  10. Race*
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  11. Nationality (Country of Birth)*
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  12. English Proficiency*
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  13. Other Language
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  14. Other Language Proficiency
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  15. Highest Grade Completed*
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  16. Employment Status*
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  17. Child's Relationship*
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  18. Custody*

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  19. Check all that apply*


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  20. If teen parent, subsidized?

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  1. Contact Information

    for Primary Adult lives with Child
  2. Living Address*
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  3. City*
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  4. State*
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  5. Zip*
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  6. Ward #
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  7. Home Phone*
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  8. Work Phone
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  9. Cell Phone
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  10. E-mail Address*
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  1. Secondary Adult

    (Lives with child)
  2. Is there a secondary Adult that lives with the child that you would like listed on the application.

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  3. First Name
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  4. Middle Name
    Invalid Input
  5. Last Name
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  6. Suffix
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  7. Nickname
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  8. Birthday
    / / Invalid Input
  9. Gender

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  10. Race
    Invalid Input
  11. Race
    Invalid Input
  12. Nationality (Country of Birth)
    Invalid Input
  13. English Proficiency
    Invalid Input
  14. Other Language
    Invalid Input
  15. Other Language Proficiency
    Invalid Input
  16. Highest Grade Completed
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  17. Employment Status
    Invalid Input
  18. Child's Relationship
    Invalid Input
  19. Custody

    Invalid Input
  20. Check all that apply


    Invalid Input
  21. If teen parent, subsidized?

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  22. Contact Information

    for Secondary Adult
  23. Cell Phone
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  24. Home Phone
    Invalid Input
  25. Work Phone
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  26. E-mail Address
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  1. Family/Household Information

  2. Child lives with*


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  3. Children in family living with child
  4. Total children ages birth to 18
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  5. Number of children ages Birth to 3
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  6. Number of children ages 4 to 5
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  1. Family Members

    (Please do not include adults and child listed previously)
  2. Number of family members living with child
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  3. Family Member (1)

  4. Name
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  5. Relationship to Child
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  6. Date of Birth (month/day/year)
    / / Invalid Input
  7. School/Current Grade or Occupation
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  8. Live with family?

    Invalid Input
  9. Provides financial support?

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  10. Family Member (2)

  11. Name
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  12. Relationship to Child
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  13. Date of Birth (month/day/year)
    / / Invalid Input
  14. School/Current Grade or Occupation
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  15. Live with family?

    Invalid Input
  16. Provides financial support?

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  17. Family Member (3)

  18. Name
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  19. Relationship to Child
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  20. Date of Birth (month/day/year)
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  21. School/Current Grade or Occupation
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  22. Live with family?

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  23. Provides financial support?

    Invalid Input
  24. Family Member (4)

  25. Name
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  26. Relationship to Child
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  27. Date of Birth (month/day/year)
    / / Invalid Input
  28. School/Current Grade or Occupation
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  29. Live with family?

    Invalid Input
  30. Provides financial support?

    Invalid Input
  31. Family Member (5)

  32. Name
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  33. Relationship to Child
    Invalid Input
  34. Date of Birth (month/day/year)
    / / Invalid Input
  35. School/Current Grade or Occupation
    Invalid Input
  36. Live with family?

    Invalid Input
  37. Provides financial support?

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  1. Government Funding Information

    To be considered for Early Head Start and/or DHS (District of Columbia), please indicate which of the following services your family receives. (Check all that apply)












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  3. Development Information

    Do you have any concerns about your child’s development, physical, or emotional progress? Has your child ever been assessed for special need? Does your child have an IEP or IFSP? If yes, please explain.
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  5. *
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Need More Info?

For tuition questions or clarification, please contact Campbell Frank at (202)265-9885 ext.115.

For Early Head Start or OSSE questions, please contact Remberto Vargas at (202)265-9885 ext. 101.

View the Admissions Applications: