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Ben & Maxine Miller Child Development Laboratory School - Registration

Completion of the application and payment of the application fee will officially register your child on the waiting list. Choose between the online registration OR the PDF paper version. Do not submit by both methods please. Complete and submit one enrollment form per child.

Application Cover Letter and Enrollment Policy pdf

Download the Application as a PDF form pdf

Step 1: Contact Information

First Parent Contact Information

Affiliation:




Second Parent Contact Information

Affiliation:




Step 2: Parent Information

The Ben & Maxine Miller Child Development Laboratory School offers a sliding fee scale. My family's Gross Annual Income is (based on anticipated tax return for the prior year)*:
$60,000"/>

*Disclosure is optional however if no data is provided the tuition rate will be based on the highest income level category

Step 3: Child's Information

Gender

I wish to enroll my child :
Read program descriptions and enrollment policy

The child named on this form is currently enrolled in:


The Children's Programs of Child Development & Family Studies support the inclusion of children with special needs in our programs.

Does your child have any special needs? Check all that apply.

If your child has no known special needs please select the first box.

Do any of the following apply to this child's Siblings? Please fill in all that apply.

When:

Sibling's name:

Step 4: Application fee

In order to cover the cost of enrolling children and maintaining our wait list, the Children's Programs require a one-time nonrefundable $20.00 per child application fee. Your child will not be placed on the waiting list until this fee has been paid. Checks should be made payable to Purdue University.

Submit application below. You must also mail or deliver your $20 application fee to:

Purdue University Children's Programs 
Fowler Memorial House, RM 190 
1200 West State Street
West Lafayette, IN 47906

Be sure to include your name and your child's name with this $20 payment.

Attention parents: It is the parents' responsibility to make sure we always have their current address and phone number in our files. Application update forms are sent out annually. If you do not return the completed form by the specified date, your child will be removed from the wait list. Unfortunately, we are unable to make any exceptions.