CCA 2018.2019 Four Year Old Preschool Application
The Clear Creek Amana Community School District is part of the State-Wide Voluntary Preschool grant and offers 16 hours (minimum of 10 hours) a week of FREE instruction to eligible participants.

Due to space limitations, an application does not guarantee a spot in the preschool program.

If enrolling your child in the school day preschool, the first tuition payment is due ON OR BEFORE August 1st, 2018. Subsequent payments will then be due on the 1st of each month starting in September. If payment is not received by this date your child may not be able to participate in the additional hours until payment is made. PAYMENTS TO PRESCHOOL CAN HAPPEN AT ANY TIME PRIOR TO THE START OF THE SCHOOL YEAR.

Will your child be 4 years old on or before September 15, 2018 *
What is your child's birthdate? *
mm/dd/yyyy
MM
/
DD
/
YYYY
Will your child be 5 years old on or before September 15, 2018? *
If YES, STOP. Your child is not eligible for the FREE portion of our preschool program and will be required to pay full tuition which will be dependent on the amount of state funds provided through the Voluntary Preschool grant. Principal permission will need to be given prior to students being able to enroll.
Do you reside in the Clear Creek Amana Community School District? *
Priority preschool placement will be given to children residing in the Clear Creek Amana Community School District. Physical addresses are subject to verification.
Your child's legal name *
Last Name, First Name, Middle Name
Your answer
Gender of your child *
Parent's/Guardian's Name(s) *
First Name, Last Name
Your answer
Parent's primary phone number *
000-000-0000
Your answer
Parent's secondary phone number
000-000-0000
Your answer
Physical street address *
House number and street name
Your answer
City, State, Zip *
Your answer
Mailing address if different from physical address
PO Box, City, State, Zip
Your answer
Parent's email address *
Your answer
I am a Clear Creek Amana School District Employee *
Race/Ethnicity
This information is requested by the Federal Government in order to monitor compliance with civil rights law. You are not required to furnish this information, but are encouraged to do so. However, if you choose not to, under Federal regulations, the program's representative is required to note race/ethnicity on the basis of visual observation or surname. The Clear Creek Amana Community School District is an EEO/AA School District.
Race
Ethnicity
Preschool attendance center
In this portion you will be choosing your first and second choice for preschool attendance center. Due to restrictions in space, not all families are guaranteed first choice.
First choice for attendance center *
Second choice for attendance center *
CCA schools will continue to collaborate with Little Clippers and Sprout Kids Academy (located in Tiffin, IA) to provide high-quality preschool programming. Both will offer the required minimum of 10 hours of free preschool a week and follow the same district and state guidelines as our school-based programs. *
Are you interested in learning more about our off site programming?
Attendance Options *
Before and After School Care
The Clear Creek Amana Community School District has contracted for on site care (at each elementary attendance center) with Little Clippers for before and after school care. Preschool students may be enrolled in the program. Enrollment in the before and after school program must be made by calling 319-545-4033. Space is limited.

Additional Information
Thank you for filling out the Clear Creek Amana Community School District 2018.2019 Preschool Application. Our goal is to notify all families of their child's placement by March 1st.

e Registration information will be sent via mail this summer with instructions on how to register your child. This process will be exactly like our process for kindergarten through 12th grade students.

The school district will need a copy of your child's birth certificate, up to date physical and immunization records after your child has been officially placed. You may drop these documents off at any elementary attendance center or:

email: colleenconrad@ccaschools.org
fax: 319-622-3108
or mail them to:
CCA Preschool
3023 220th Trail
Amana IA 52203

*Although the district expects 9 payments of $285 starting August 1st, tuition can be paid in full at anytime prior to the conclusion of the school year. In the event the District feels adequate payment has not been made on tuition, the District reserves the right to restrict preschool to the Free portion only until reasonable and agreed upon payments are in place. This extreme measure will be communicated in advance.

BY CLICKING ON “YES”, YOU ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO THE TERMS AND CONDITIONS OF THIS APPLICATION *
Name of person submitting this application *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Clear Creek Amana CSD. Report Abuse - Terms of Service - Additional Terms