Infant, Toddler, & Preschool Online Eligibility Form

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Please complete this eligibility form for San Juan Unified School District's Early Childhood Education programs.

You may find a map of all of our program locations here >> Infant, Toddler, & Preschool Programs Map

This form must be submitted by a parent/legal guardian.
Complete one form for each student.
A staff member will get back to you within seven working days if there are any issues with your submission.
You must meet all requirements in order to qualify for our programs.

Please visit our website for more information on requirements if needed:

Email *

How did you first hear about our program?
(Select all that apply)

Word of mouth (friend, family, coworker)

Social media (Facebook, Instagram, etc.)

Online search (Google, Bing, etc.)

Community event or fair

Flyer or brochure

Referred by another school or childcare provider

Required

Full Name of Child Enrolling *

For pregnant mothers enrolling for Home Based program—please type your full name

Child's date of birth *

For pregnant mothers enrolling for Home Based program—please type their birthday

YYYY

Child's gender *

Male

Female

Other:

Program *

Pregnancy to 36 mos. (Home Based)

18-36 mos. Toddlers (Center Based)

36mos. - 5yrs. Preschool (Center Based)

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