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Pickerington Preschool 24-25 Application
Thank you for your interest in Pickerington's Early Childhood Program.  Please complete this form and click the submit button at the bottom to apply for the 2024-2025 school year.  If you have any questions, please contact Sherri Dittoe at 614-920-6162 or Tammy Pruden at 614-920-6163.
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Date Submitted
Estimated tuition fee is 241.84 per month
For students who do not qualify as having a disability, you will be charged a tuition fee of 16.00 a day with an estimated charge of 241.84 per month.
Child's First Name *
Child's Middle Name *
Child's Last Name *
Nickname *
Child is: *
Child's Date of Birth *
Note:  Your child must be approximately 3 years old to attend
Address *
City *
State                                             *
Zipcode *
Parent/Guardian's Name 1 *
Parent/Guardian's Name 2
Home Phone Number
(with area code)
Mom's Cell Phone Number
(with area code)
Mom's Email Address
Dad's Cell Phone Number
(with area code)
Dad's Email Address
Do you suspect any problems with your child's development? *
If yes, please list your concerns.
Does your child currently have an IEP from another school district?
Clear selection
Please complete the section below by marking yes or no.
Eats and drinks independently
Dresses self except for shoes
Independent with toileting needs (may need help with difficult snaps or buttons)
Verbally interacts with peers in a play situation
Makes basic needs known
Responds to simple questions
Follows simple directions
Speaks in sentences
Independently picks up small toys
Uses toys and objects appropriately
Uses imagination to play
Will share toys and cooperate in play
Takes turns with minimal assistance
Shows understanding of how things work by turning things on/off, activating a variety of toys, or directing adults to do so
Other preschool experiences your child has had:
How well does your child separate from parents? *
What language do you primarily speak to your child? *
What other languages are spoken in the home?
Would you like an interpreter present at your child's scheduled evaluation?
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If yes, what language?
Please describe your child's strengths: *
Please describe what is difficult or challenging for your child: *
What are your child's interest:
Please describe how well your child interacts with other children his/her age: *
Why would you like for your child to be enrolled at Pickerington Local Preschool? *
Please select your preference for preschool. *
select am or pm
Are there any custody concerns? *
Please select one of the options below.
Kindergarten start date *
The Sections below are required for all applicants but will only apply for Peer Models.
If you have any questions, please contact Tammy Pruden at 614-920-6163 or Sherri Dittoe at 614-920-6162.
If my child is accepted as a peer model, I agree to pay the established tuition of 16.00 per day or an estimated tuition of 241.84 for 9 payments due on the 5th of each month.   *
(My student will attend 4 days a week for 2.75 hours a day, Monday - Thursday)
If my child is accepted as a peer model, I understand I am required to provide transportation for my child to and from school. *
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