Alcott Integrated Pre-School Program Lottery Application 2022-2023
This application form is to submit your child's name for the Alcott Elementary School Pre-School Lottery Program for the 2022-2023 school year as a peer role model. Completion of this form DOES NOT guarantee your child a spot in the Pre-School Program.

The Lottery Application Process will close on March 11, 2022. The lottery selection will be completed after that and you will be notified by the Department of Student Services if your child is selected.

Residency Requirements must be met in order to be enrolled in the Pre-School Program.

Please visit the Wolcott Public School's District website to view Residency Requirements. https://www.wolcottps.org.

If you have any questions, please contact Student Services at 203-879-8178.
Sign in to Google to save your progress. Learn more
Child's First Name *
Child's Middle Name (If applicable)
Child's Last Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Child's Age *
Gender *
Home Address *
Contact 1 Name (First and Last) *
Contact 1 Phone Number *
Is this a home, mobile or work number? *
Contact 1 Email Address *
Contact 2 Name (First and Last) *
Contact 2 Phone Number *
Is this a home, mobile or work number? *
Is the student Hispanic or Latino? *
Students Race/Ethnicity - Please check all that apply *
Required
Does your child have any siblings that are currently attending Wolcott Public Schools? *
If yes, please list names of siblings.
Has your child ever been in a pre-school program before? *
If yes, please list what program, dates of enrollment and location.
Has your child ever received or is currently receiving services from Birth-to-Three? *
If yes, what services and which provider?
Is your child receiving outside private services? *
If yes, what services and who is the provider?
Do you have concerns regarding your child's development? *
If yes, please explain your concerns.
What are your child's favorite activities? *
What types of experiences would you like your child to enjoy in pre-school? *
What would you like us to know about your child? *
What are five adjectives that best describe your child? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Wolcott Public Schools. Report Abuse