Northwest ECE Free Tuition Preschool Application 2021-22
The Northwest Preschool program is a grant funded preschool by the Ohio Department of Education. Your child should turn 4-years-old and be potty-trained by September 30, 2021 to be eligible. Families earning at or below 200% the Federal Poverty Level will receive free tuition and will pay nothing to attend the preschool program. If your family's income is above 200%, DO NOT FILL OUT THIS FORM. You will pay tuition according to the chart found in this form and should fill out the Northwest PAID Preschool Application at https://forms.gle/63mxFShbqa8NSKcJ7.

Under the grant rules, we are required to determine student eligibility based on two factors: income and age. To determine if your child meets the income eligibility requirements, and for your application to be complete, YOU MUST answer all of the questions in this form AND provide proof of income.

Choose one of these many different ways you can submit your proof of income (2020 Tax Forms or last two pay stubs for each person in your home):
1) Take a picture of your income documentation and email it directly to melyssa.shannon@nwmohawks.org
2) Use the Notes app on an iPhone to scan and email documents to melyssa.shannon@nwmohawks.org (Learn
how at https://support.apple.com/en-us/HT210336
3) If you have a Google account, you can upload your income forms at https://forms.gle/vrfkU9ekrJFqjupq8
4) Bring your documents to the school and we will make a copy to keep for our records

If you are unable to provide documentation of income, the only way you can complete the application is by completing the form (click on link below) indicating that you are homeless, receive no income or cannot provide income documentation because it was destroyed or lost as a result of being homeless. If any of these describe your family, YOU MUST COMPLETE the form found at https://forms.gle/sAY8fWyiUK8f3bvo8

Our classes meet Monday through Thursday during regular school hours. Transportation is provided to and from school for children residing in the Northwest Local School District.


Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Age by September 30, 2021 *
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Gender
Is your child potty trained?
Clear selection
Parent/Guardian Name(s) *
Parent/Guardian Address (Street, City, State, Zip Code) *
Parent/Guardian Telephone Numbers *
Number of people living in the household *
Gross Annual Income of Household for 2020
Please list each person living in your home. Include: Name, Relationship to You, and Date of Birth (ex: John Smith, spouse, 1/23/1980; Judy Smith, mother-in-law, 5/12/1965; Johnny Smith, son, 1/23/1996, etc.) *
Will you or the people in your home receive income this month? *
Required
Are you able to provide documentation of income? If you answer "NO" to this question, the only way you can complete this application is by completing the form (click on link below) indicating that you are homeless, receive no income or cannot provide income documentation because it was destroyed or lost as a result of being homeless. If any of these describe your family, YOU MUST COMPLETE the form found at https://forms.gle/sAY8fWyiUK8f3bvo8
Clear selection
Please list the person receiving income, type of income, AMOUNT of Income (BEFORE TAXES), how often received (weekly, bi-weekly, etc.), date last received. *
Do you or anyone in your household pay Child or Spousal Support? *
Required
If you pay child or spousal support, please list the amount and how often it is paid.
Please type the name of the person completing this form and your relationship to the child. *
Email of parent/guardian
Submit
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