Preschool Application for Attendance
2021-2022 School Year
Filling out this form does NOT guarantee enrollment. This gives us basic information to begin planning for next school year. You will still do full enrollment through the district. Thanks!
Email address *
In which district are you applying for preschool? *
Child's First & Last Name *
Child's Date of Birth *
Child's Gender *
Child lives with: *
Parents' Marital Status *
Mother's Name
Mother's Date of Birth
Mother's Highest Education Level
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Father's Name
Father's Date of Birth
Father's Highest Education Level
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Child's Address *
Mailing Address *
Best Phone Number *
Additional Phone Number
Is your child receiving any special services (i.e. speech therapy, special education)? *
Does your child have an IEP (Individualized Education Program)? *
What language is spoken in your home? *
Was either parent under the age of 20 when the child was born? *
If your child has a case number for Food Stamps, TAF, FDPIR or FAP, please list here.
How many people live in your household? *
Does your family exceed the annual income guidelines listed below for the number of people in your household?
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If not, there is some income information required that does not fit well on this format. A form may be mailed to your mailing address listed above. Please return it to the school ASAP. Thank you!
Does another child in your household qualify for free or reduced lunches in the district?
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Thank you! If you have any questions, please feel free to contact Janine Henry, Preschool Coordinator, at
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