Request For Child Care Information

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University Human Resource Services
Administration Building, Room 350
Muncie, Indiana 47306
Phone: (765) 285-1834
Fax: (765) 285-8663
humanresources@bsu.edu
Hours: 8 AM-5 PM, M-F

Request For Child Care Information

Please provide the following contact information. If you submit this request form, you must also submit a printed and signed Disclaimer form and send it to:
Marta Stephens
AD 350
Ball State University
Muncie, IN 47306

Items with an * indicate a required field.

Have you printed and filled out the disclaimer form? *	Yes No
You must print, fill out, and send in a disclaimer form along with this form to complete your information.
First Name *
Middle Initial
Last Name *
Status *
E-mail address *
BSU Department

Address Line 1 *
Address Line 2
City *
State *
Zip *
Phone *
Number of Children *
Ages of Children *
Expecting/Due Date
School District
Relative Affiliated with BSU and his or her job title
Work Phone
Type of Care You are Interested In *
How Did You Hear About Us?
Will child care availability affect your decision to stay at BSU? *	Yes No
Full time care needed (21 hours or more) *	Yes No
Part time care needed (20 or fewer hours) *	Yes No
Continuation of full or part-time *	Yes No
Comments

Please go here to view the disclaimer information.