Disenrollment

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DISENROLLment

Disenrollment

Complete the form below if you have a child that is no longer present at your site.
Please note that this form should only be completed for a child receiving subsidy through The Rutgers Southern Regional CCR&R.

* Indicates required field

The County in Which Your Site is Located *

Child's Name *

First

Last

Guardian's Name *

First

Last

[object Object]

Family ID *

Last Date Child Attended *

Reason for Disenrollment *

Your EPPIC ID *

Submit

Rutgers Southern Regional CCR&R Agency

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Home
Families
Early Care Providers
FCC/FFN
- Getting Started
- CPR/First Aid; new FCC/FFN; etc.
Helpful Links
Policy Updates for Providers
Important Updates
Employment Opportunities
Contact Us
Online Payments Options