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Longview Kinder Bridge Program Application
Longview Kinder Bridge will run Monday - Friday for 5.5 hours (9:30am - 3:00pm).
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* Indicates required question
Email
*
Your email
Parent(s)/Guardian Name
*
Your answer
Home Address (must reside in Longview School District)
*
Your answer
Phone Number
*
Your answer
Primary language spoken in the home?
*
Your answer
Has your child ever qualified for or been enrolled in a special education program (have an IEP)?
*
Yes
No
I don't know.
Child's Name
*
Your answer
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)
*
MM
/
DD
/
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
Name of preschool/childcare/center/location child attended. If not applicable, leave blank.
*
Your answer
Does your child have any siblings attending Longview Public Schools?
*
0
1
2
3
4
5
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
No
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
No
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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