Longview Kinder Bridge Program Application: 2025-2026

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Email *

Parent(s)/Guardian Name *

Home Address (must reside in Longview School District) *

Phone Number *

Primary language spoken in the home? *

Has your child ever qualified for or been enrolled in a special education program (have an IEP)?

Yes

I don't know.

Child's Name *

Child's Date of Birth (Students must turn 4 yrs. old by August 31st in order to qualify and can turn 5 after August 31st to qualify for program) *

YYYY

Has your child attended...(mark all that apply)

***Please notify Head Start that your family has applied to the Kinder Bridge program.

Public Agency - State or Federal FREE preschool (Example: Head Start, ECEAP)***

Preschool (Example: Smart Start, St. Rose, Sonshine Preschool, etc.)

Broadway Learning Center Special Education (SPED) Program

Private Childcare (Example: Wee Care, Kinderland, Faith Family, etc.)

In-home Childcare (Example: Becki's Daycare, April's Daycare, etc.)

Family / Friends are providing childcare

Other early learning programs

None

Required

permission to contact: We must contact prior childcare providers to determine eligibility.

Do we have your permission to contact previous preschool providers?

Yes

Name of preschool/childcare/center/location child attended. If not applicable, leave blank.
*

Does your child have any siblings attending Longview Public Schools? *

More than 5

This is the Longview Public Schools Educational Benefits Income Chart

Head Start & ECECAP Income Chart

Are you eligible for educational benefits?
*

Yes

Maybe

Will you be seeking district transportation for this program?

**this question is for planning purposes for the district and program, and restrictions will apply

Yes

Maybe

Per WA state requirement, an assessment tool will be used to determine eligibility and may include tests of pre-literacy, math, fine motor, and social-emotional development.
*

Yes, I consent to the assessment.

No, I do NOT consent.

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