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Preschool Application
Submit by March 1st
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* Indicates required question
Child Information
Last Name
*
Your answer
First Name
*
Your answer
Middle Initial
Your answer
Date of Birth
*
(mm/dd/yy)
Your answer
Age as of July 31st
*
(Child must be at least age 3 by July 31st)
Your answer
Gender
*
M
F
Required
Primary Language
*
English
Other:
Required
Child resides with
*
Both parents
Mother
Father
Other:
Required
Custodial Parent/Guardian Information
Parent/Guardian Name(s)
*
Your answer
Street Address
*
Your answer
City/State/Zip
*
Auburn, NE 68305
Brownville, NE 68321
Peru, NE 68421
Other:
Required
Preferred Contact Number (000-000-0000)
Your answer
Alternate Contact Number (000-000-0000)
Your answer
Email Address
Your answer
Apply for a Tuition Waiver
I may qualify for a tuition waiver based on:
Child's VERIFIED DISABILITY
Child's VERIFIED PREMATURE BIRTH (36 weeks or less)
Mother's VERIFIED TEEN STATUS at time of birth
Family VERIFIED FREE/REDUCED LUNCH status
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** APPLICATION MUST BE SUBMITTED BY MARCH 1st **
SUBMITTING THIS APPLICATION DOES NOT GUARANTEE ENROLLMENT.
Parents of children accepted to the program will be notified at a later date.
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