Math in the Mail 2018-19 Enrollment Form
Math in the Mail is a FREE program that focuses on developing math skills in three-year-olds, by providing the tools needed for parents, guardians, and other caregivers. By increasing pre-school aged math skills and confidence, Math in the Mail will help children gain the math knowledge that will help them have more positive and meaningful science, technology,
engineering and math (STEM) learning experiences in the future.

To qualify to receive Math in the Mail for FREE*, families must:
•Live in Arenac, Bay, Clare, Gladwin, Gratiot, Isabella, Midland or Saginaw county (Michigan)
•Have a child in the household born September 2, 2014 through September 1, 2015
•Have a household income that is at or below 250% of the federal poverty guidelines (found at https://www.michigan.gov/documents/mde/GSRP_Income_Eligibility_Guidelines_020817-ADA_551180_7.pdf)

*Math in the Mail is available by subscription for families who do not qualify for the free program. Visit https://docs.google.com/forms/d/e/1FAIpQLSfgrUsl9VknD1PeWTdNgkxE-8YVXW0N6cr6KxT8KR3htZySwg/viewform?usp=sf_link for more information on the subscription option.

Qualifying families can expect to start receiving Math in the Mail kits September 2018.

Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Birthday (must be born 9/2/14 - 9/1/15 to qualify to receive kits this year) *
MM
/
DD
/
YYYY
Parent's Name *
Your answer
Parent's Email *
Your answer
Parent's Phone Number *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
The Math in the Mail kits come in boxes. If a kit doesn't fit into your mailbox, is there another place the mail carrier could leave it? (For example, many people direct USPS to leave boxes at their door or with the apartment building office.) Please note: if no direction is given and a kit doesn't fit into your mailbox, the mail carrier will leave a note for you and you may have to go to the local post office to pick up the kit. *
Your answer
County *
Address to mail kits to (if different than above):
Your answer
What is your child's primary language? *
Your answer
How did you hear about Math in the Mail? *
Required
Children entering a Head Start or GSRP four-year-old preschool program will be assessed at the beginning of the school year. This assessment information can be used to gauge the effectiveness of the Math in the Mail program and to help secure further funding for the program. The Family Educational Rights and Privacy Act (FERPA) requires consent from parents/guardians to access each child's assessment information. Information about the Family Educational Rights and Privacy Act (FERPA) can be found at www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html *
I am the legal parent/guardian of the child named above. [Please type your first and last name below, to be used as your signature.]
Your answer
Does your family receive... (please check all that apply) *
Required
If your family receives Medicaid, Bridge Card, or WIC, please list your ID number here (this will count as proof of income)
Your answer
My family qualifies for Head Start or GSRP preschool. *
If you answered yes above, does the Math in the Mail Coordinator have permission to use your proof of income information on file with Head Start/GSRP to qualify your family for Math in the Mail?
What is the annual gross income of your household? *
Your answer
How many children are living in your household? *
Your answer
How many adults are living in your household? *
Your answer
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