APPLICATION FOR ENROLLMENT
Global Roots Play School
402 North Aurora Street
Ithaca, NY 14850
director@globalrootsplayschool.org
Email address *
Desired Start Date (School runs from Sept-June and has “rolling enrollment” so if there is space children can be enrolled mid-year)
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Desired End Date (If before end of year)
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Days per Week requested
Applicant Information
Child’s full name: *
Your answer
What you want us to call your child:
Your answer
Child’s gender: *
Child's Date of Birth: *
Your answer
Parent name (1): *
Your answer
Parent name (2):
Your answer
What ESL classes are you attending *
Is Either Parent attending or working at Cornell? *
Parents preferred language(s): *
Your answer
Child's preferred language(s): *
Your answer
How long have you been in Ithaca? *
Your answer
How long do you plan to stay in Ithaca? *
Your answer
Home address: *
Your answer
Home phone: *
Your answer
Email Address *
Your answer
Names and ages of siblings:
Your answer
Allergies or other medical concerns:
Your answer
Other information we should know (including child’s other experiences with daycare/preschool/babysitters, etc.):
Your answer
Tuition
In the United States, most small schools for children under age 5 are funded only by the tuition that is charged to families.

Global Roots Play School is committed to being affordable to all families so we
provide scholarships with a sliding scale to all families who need them. To do this, Ithaca Welcomes Refugees and Global Roots raises funds through public fundraisers, grants from foundations, and donations from people in the Ithaca community.

Your help in determining a fair tuition rate for your family to pay is greatly appreciated.

Occupation(s): *
Your answer
Employer(s): *
Your answer
Annual Family Income (without deductions as it appears on your federal tax form line 22) *
Your answer
Family Size (number of family members living on annual income) *
Your answer
Does your family have other sources of income, including income that is not required to be reported on the Federal tax return (for example, financial support from other relatives, real estate, investments, inheritance, trusts, etc.)? *
If so, how much on a yearly basis? *
Your answer
If your income is 0 can you please help us understand how you support your family? *
Your answer
Is there anything else you feel we should know? *
Your answer
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