GSRP Pre-Screen Form
Parents complete this form if you are interested in free preschool for you 4 year old!
Child's Birth Date *
MM
/
DD
/
YYYY
Child's Full Name *
Child's Sex *
Child's Street Address, City, and Zip Code *
Phone Number *
Alternate Phone Number
Parent E-mail *
Parent/Guardian's Name *
Parent/Guardian's Name
Number of ALL (self, children, and other adults) household members for which you are financially responsible for: *
Gross Income and Frequency (i.e. weekly, bi-weekly, 2 times/month, monthly) *
Submit
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