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2025-26 THREE OR FOUR-YEAR OLD PRESCHOOL APPLICATION 
COMPLETING THIS FORM DOES NOT GUARANTEE ENROLLMENT INTO THE CLASS - CERTAIN CRITERIA ARE REQUIRED FOR ACCEPTANCE. THIS FORM NEEDS TO BE COMPLETED BY JULY 1ST. ENROLLMENT WILL BE FINALIZED AUGUST 6TH.
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Email *
Student Last Name *
Student First Name *
Birthdate *
MM
/
DD
/
YYYY
Gender *
Required
Ethnicity *
Primary language spoken at home: English *
Required
If primary language is not English, what is the primary language?
Does your family have Migrant Status? *
Are you aware of any developmental or academic delays in your child's development?  *
Required
Does your child have a documented IEP or receive  Special Education services (i.e. speech, PT/OT, OCCK/LCNCK)? *
Required
If your child receives Special Education services, what services do you receive?
Has DCF Referred you to our program? *
Required
Are you currently enrolling a student in Foster Care? *
Do you experience Chronic or Episodic Homelessness? *
Required
Does your family qualify for free lunches? *
Are / were you a teen parent (19 or younger) when this child was born? *
Required
Are you a single parent/unmarried (Not married by the first day of school)? *
Required
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