AMA Great Start Readiness Program Pre-Application
Children must be 4 years old on or before September 1st and fully toilet trained
* Required
Free Preschool for 4 year olds meeting program eligibility guidelines.
Date of Application
*
MM
/
DD
/
YYYY
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Gender
*
Female
Male
Child's Date of Birth
*
MM
/
DD
/
YYYY
With whom does the child reside?
*
Mother
Father
Both Parents
Legal Guardian
Foster Care
Other:
Child's Home Address
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Mother's Name
Your answer
Mother's Address
Your answer
Mother's Phone #
*
Your answer
Mother's Marital Status
Choose
Married
Single
Divorced
Widowed
Separated
Father's Name
Your answer
Father's Address
Your answer
Father's Phone Number
*
Your answer
Father's Marital Status
Choose
Married
Single
Divorced
Widowed
Separated
Total number of people living in the household
*
Your answer
Total number of people working
*
Your answer
Estimate of Income in the household (please specify if weekly, biweekly, monthly or annually)
*
Your answer
Are there any other factors that you think may qualify you for the GSRP program?
*
Your answer
Family Email Address
*
Your answer
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