PRESCHOOL CRITERIA SHEET

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Only fill in this form if you are registering your child for preschool.

Child's Name (first and last) *

Child's Date of Birth *

YYYY

Legal Parent/Guardian Name *

Does the child speak English? *

Yes

Was the child born to a teen parent? *

Yes

What is the parent's highest level of education? *

No high school diploma

High school diploma or GED

2 year degree/certificate

4 year degree

Advanced degree

Is the parent/guardian a current student? *

Yes, a student in a trade school

Yes, a student attending college

Does the child have an incarcerated parent? *

Yes

Does the child have a recently deceased parent? *

Yes

What is the current marital status of the child's BIOLOGICAL parents? *

Biological parents are married to each other

Biological parents have never been married to each other

Biological parents are divorced from each other

Does the child receive SNAP benefits? *

Yes

Is there a family history of physical abuse? *

Yes

Is there a family history of drug abuse? *

Yes

Is the legal guardian someone other than a biological parent? *

Yes

Does the child have a parent currently in the military? *

Yes

Has your child been referred to our Preschool by an agency? *

Yes

If yes to the previous question, please state the agency that made the referral.

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