Northwest PAID Preschool Application 2021-22
This application is an application for PAID spots in the Northwest Preschool Program. If you are filling out this form, you expect to pay monthly tuition. Your child should be potty-trained and preference is given to children who are 4-years-old by September 30, 2021. The Northwest Preschool program is a grant funded preschool by the Ohio Department of Education, but we are fortunate to be able to offer just a few spots in these classes for families who are above income. These spots are first come, first served and require a monthly tuition payment. Monthly tuition is based on gross annual household income. Families with income above 200% will pay tuition according to the chart found in this form. Families earning at or below 200% the Federal Poverty Level will receive free tuition and will pay nothing to attend the preschool program. If your gross household income falls in the 200% or below range, STOP! You must fill out the Northwest ECE Free Tuition Application at https://forms.gle/xQapdk9koJvkB9bp9

If your income falls between 201% and 349%, you could qualify for a reduced tuition rate. You may submit your proof of income (2020 Tax Forms or last two pay stubs for each person in your home) by any of the methods listed below. You do not have to do this today for your initial application.
1) Take a picture of your income documentation and email it directly to melyssa.shannon@nwmohawks.org
2) Use the Notes app on an iPhone to scan and email documents to melyssa.shannon@nwmohawks.org (Learn
how at https://support.apple.com/en-us/HT210336
3) If you have a Google account, you can upload your income forms at https://forms.gle/vrfkU9ekrJFqjupq8
4) Bring your documents to the school and we will make a copy to keep for our records

Our classes meet Monday through Thursday during regular school hours. Transportation is provided to and from school for children residing in the Northwest Local School District.

Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Age by September 30, 2021 *
Child's Date of Birth *
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DD
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Child's Gender *
Is your child potty trained? *
Parent/Guardian Name(s) *
Parent/Guardian Address (Street, City, State, Zip Code) *
Parent/Guardian Telephone Numbers *
Number of people living in the household
Gross Annual Income of Household for 2020 (If you do not choose to answer this question now, you can provide income verification later for a reduced tuition rate)
Please type the name of the person completing this form and your relationship to the child.
Email of parent/guardian
Submit
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