Northwest Preschool Application 2020
This application is an INTEREST application, and it is important that you complete ALL questions. The Northwest Preschool program is a grant funded preschool by the Ohio Department of Education. 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. Families earning at or below 200% the Federal Poverty Level will receive free tuition and will pay nothing to attend the preschool program. Families with income above 200% will pay tuition according to the chart found below. Under the grant rules, we are required to determine student eligibility based on two factors: income and age. If your child TENTATIVELY meets the eligibility requirements, we will contact you for additional information and paperwork to verify your income. Your child should turn 4-years-old by September 30, 2020 and be potty-trained. Thank you.
You can scan and email a picture of your income documentation to ronda.sissel@nwmohawks.org. (Click here to see how to use Notes app on an iphone to scan and email documents)


Child's First Name *
Your answer
Child's Middle Name *
Your answer
Child's Last Name *
Your answer
Child's Age by September 30, 2020 *
Your answer
Child's Date of Birth
MM
/
DD
/
YYYY
Child's Gender
Your answer
Is your child potty trained?
Parent/Guardian Name(s)
Your answer
Parent/Guardian Address (Street, City, State, Zip Code)
Your answer
Parent/Guardian Telephone Numbers
Your answer
Number of people living in the household
Your answer
Gross Annual Income of Household for 2020
Your answer
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.) *
Your answer
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
Please list the person receiving income, type of income, AMOUNT of Income (BEFORE TAXES), how often received (weekly, bi-weekly, etc.), date last received. *
Your answer
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.
Your answer
Please type the name of the person completing this form and your relationship to the child.
Your answer
Email of parent/guardian
Your answer
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