Early Childhood Peer Application
The Monona Grove School District is currently seeking three-year olds to join in our Early Childhood programs as peer models for the 2017-2018 school year. It is anticipated that all children will naturally provide social experiences and authentic interactions in a large group setting. All children will benefit from engagement in age-appropriate learning opportunities and will gain empathy, leadership, communication, and school readiness skills. We are seeking peer models that willingly engage with and model positive peer interactions. Peer models should demonstrate age-appropriate play, early learning, behavior, communication, social skills, self-care, motor skills, and speech and language skills.

In order to be eligible as an early childhood peer model, children need to:
*Enroll in the School District
*Be 3 years of age on or before September 1st of the school year to participate
*Be independent with toilet needs
*Demonstrate age appropriate development as demonstrated through observations and developmental checklists
*Willingly interact and play with other children
*Be transported to and from the program daily
*Maintain regular attendance

If you are interested in applying to have your child join our Early Childhood Program as a peer model for the 2016-2017 school year, please complete the following application questions. Please allow for roughly 15 minutes to complete the application. We appreciate your time and responses. Once your application is reviewed, a staff member will be in contact with you regarding the status of your application.

If you need assistance in completing this form, need information communicated in a different way, or have further questions please call Christa Macomber at 608-316-1908.

***Please Note*** The application window for the 2017-2018 School Year has now closed. If you wish to apply, your child will be put on a wait list and you will only be contacted if an opening becomes available. Thank you for your interest in the program!

Child’s Information
First Name: *
Your answer
Last Name: *
Your answer
Date of Birth *
Gender *
Primary Language Spoken at Home *
Your answer
Select one or more of the following categories that apply to your child *
What is your relationship to the child? *
Primary Guardian(s) Information
Name *
Your answer
Address *
Please include street name/number, city and zip
Your answer
Phone Number & Best Time to Call *
Your answer
Email Address
Your answer
Does your child have a Secondary Guardian? *
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