2018/19 PreKindergarten Interest Form
Please fill out the form completely and be sure to click the "submit" button at the bottom when finished.
Child's First and Last Name *
Please write legal name and in parentheses ( ) preferred nickname. ex. Benjamin (Ben) Smith
Your answer
Child's Birthdate (child must have been born on or before September 1, 2014, but NOT before September 1, 2013) *
MM/DD/YYYY ex. 03/15/2014
Your answer
Parent/Guardian(s) First and Last Name(s) *
Please provide name(s) of parent/guardian(s) child lives with
Your answer
Child's Address *
Please provide home address where child resides 50% or more of the time
Your answer
Parent/Guardian(s) Phone Number(s) *
Please provide phone numbers along with descriptive information. ex. 503-805-XXXX - Mom Cell
Your answer
Main Email Address *
Please provide one or more emails that will be checked the most frequently. Double check your typing, please! If you do not have an email address, type "none."
Your answer
Is child's living address located within the Hopkins Elementary School boundaries? *
You can go to the following website to check: https://drive.google.com/file/d/0Bw0Ztj_z11QBRkJxNE9kMFJSVlU/view
What languages are spoken in the home? *
Select all that apply
Required
Does your child fit into any of the following categories? *
Select all that apply
Required
Is your child currently on an Individual Family Service Plan (IFSP)? *
Does your child get early intervention services from the NW Regional Education Service District (NWRESD)? (Many students who receive speech support are on an IFSP)
If you answered "Yes" to the previous question, please list for what purpose.
What is the qualification for the IFSP? ex. speech articulation
Your answer
We are able to use family income as part of our criteria for accepting students into our program. This information is optional and will be kept confidential. Do you wish to provide your family income? *
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