---

Alice's Rainbow Childcare Centers
Request for Information Form

---

Please take a moment and answer the questions below. We are happy to respond to general or specific requests. We especially want to know more about who our visitors are and how we can help you with your Childcare questions.

Please choose one response to the questions below, and--if you wish--include a short note of comments or requests in the block. Thank you for your time.

---

---

Which of the following best describes you?
University of Iowa Faculty/Staff Parent
University of Iowa Student Parent (Undergraduate)
University of Iowa Student Parent (Graduate)
Iowa City Parent
Childcare professional or provider
Other (please explain below)

---

You came to our webpage due to which of the following?
E-mail list or referral
Another web site
Non-Internet referral (friend, word of mouth, etc.)
Keyword search on a search engine

---

Please let us know what you would like to have information about
(Be sure to give us an e-mail/contact address!! Also explain in detail where necessary using the text box below):
I am a UI Student and would information on scholarhsip assistance with Childcare costs
I'm interested in any upcoming events or lectures you have
Can I get some information on your centers, or tour them?
I'd like to get on the waiting list
Can I get an update on the waiting list? (be sure to give contact info below)

---

Would you like to participate in our Childcare community?
I can offer supplies or toys I can donate time to administrative work I can offer labor time on projects or building I'm happy to help with publicity and mailings

---

Your email address:

You contact information, questions, etc.
(Enter message)

---

---

Home	Navigate the Site	Mail:Center Director

---