Preschool Application, 2017-18
There are tuition free preschool programs throughout Huron County for children 3 and 4 years of age. To apply, complete the application below and click the submit button. If you would like help completing this form or have questions please call 989-269-6533. To finalize your application you must also mail a copy of your child’s proof of age and immunization record, and your most recent income tax return and drivers license to Huron County Great Start, 1299 South Thomas Road, Bad Axe, MI 48413.

Preschool placement is based on a child’s age, family income, child’s need and availability of programming. The state and federal governments have determined that government funded preschool programs will be available at no cost for families who meet the income guidelines. There are a small number of over income placements (for a fee) for children who are at-risk for educational failure.

Please excuse the personal nature of some of the questions. Your answers will help determine if your child is eligible for a Great Start Readiness or Head Start Preschool Program. If you are eligible for Head Start you will need to complete additional enrollment forms with a Head Start representative.

What preschool program are you applying to?
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Middle Name
Your answer
Child's Birth Date
MM
/
DD
/
YYYY
Gender
Street Address
Your answer
City
Your answer
Zip Code
Your answer
Resident School District
Child's Race (check all that apply)
Check the box(es) that you believe best discribes your child.
Required
Child's Ethnicity
Any Hispanic or Latino?
Primary Language Spoken in the Home
Relationship Status of Child's Parents
Required
Parent/Guardian Last Name
Primary Caregiver (person we will call or follow up with)
Your answer
Parent/Guardian First Name
Your answer
Parent/Guardian Email Address
If you provide your email address, you will receive a confirmation email of your application.
Your answer
Alternate Phone Number
Your answer
Parent Place of Employment
Your answer
Second Parent/Guardian Last Name
Your answer
Second Parent/Guardian First Name
Your answer
Second Parent/Guardian Phone Number
Your answer
Second Parent/Guardian Place of Employment
Your answer
Number of people in your household?
Your answer
What is your family's total gross (before taxes) annual income?
You may provide an estimate if you are unsure.
Your answer
Who does the child live with and what is their relationship to the child?
List all persons living in the home and ages of siblings.
Your answer
Does your family receive cash assistance?
Through the Department of Human Services
Does your family receive food assistance?
Through the Department of Human Services.
Is your family homeless?
This includes any situation where you do not have permanent housing.
Is this a foster child?
Do you or your child receive Supplemental Security Income (SSI) or Social Security Disability Income (SSDI)?
Does your child have a developmental delay?
If yes or unsure, explain
Your answer
Do you think your child talks, moves or acts the same as other children who are the same age?
If no or unsure, explain
Your answer
Have you been told your child is eligible for special education services?
Is your child receiving or has he/she ever received Early On services, speech, physical, or occupational therapy?
If yes, explain
Your answer
Does your child have a diagnosed long term medical condition?
If yes, explain
Your answer
Has your child's behavior ever prevented his/her participation in a group setting?
If yes, explain
Your answer
Check any/all of the following that apply to your child's recent or present behavior:
Has your child ever been referred for mental health services?
Do both parents have a high school diploma or GED?
Are both child's parents able to read?
Do any of your child's siblings have any difficulties in school or are you concerned about their development?
Has anyone in your home ever been a victim of physical/domestic/sexual abuse or neglect?
Has your family ever been involved with or investigated by Child Protective Services?
Does anyone in your household have a suspected alcohol or substance abuse problem?
Has your child suffered a parental loss due to death, divorce, incarceration, military service, or absence?
If yes, explain
Your answer
How old was this child's mother at the birth of her first child?
Your answer
How old was this child's father at the birth of his first child?
Your answer
Do you reside in a high-risk neighborhood?
High poverty, crime or limited access to critical resources.
If yes, explain
Your answer
Has your child ever been exposed to toxic substances?
Tobacco, lead, pesticides, other.
Do you suspect your child may have been exposed to toxic substances before birth?
Tobacco, fumes, pesticides, drugs, alcohol, other.
Are you interested in:
Check all that apply
Do you need bus transportation or will you be transporting your child?
Some locations use the Thumb Area Transit while others use a regular school bus.
By submitting this form you are giving permission for this information to be shared among the Head Start and Great Start Readiness Preschool Programs in Huron County to determine your child's eligibility. Type your name in the box provided below as your electronic signature.
To finalize your application you must also mail or fax a copy of your child’s proof of age and immunization record, and your most recent income tax return and drivers license to Huron County Great Start, 1299 South Thomas Road, Bad Axe, MI 48413. Fax number 989-269-3403. Your child's application will not be processed without these documents.
Your answer
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