School Readiness Application
Through a School Readiness grant funded by the Connecticut Office of Early Childhood, there are a number of spaces available in high-quality preschool programs at a reduced cost.

For the 2021-2022 school year, the Colchester School Readiness Program is actively seeking:
· Children who are not enrolled in a preschool program;
· Children who live in Colchester;
· Families who want a 5 day a week program;
· Families who may find it difficult to pay for preschool
Email address *
Your Child's Street Address. Colchester residency will be verified before placement. *
Child's First Name *
Child's Middle Name
Child's Last Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Name of Parent to Contact *
Phone Number of Parent to Contact *
What option(s) below are you interested in? *
Captionless Image
Required
Primary Language in Home *
Gross Total Income of your Household from 2020 tax return. Income will be verified before the placement of a child into a program. Include Wages, SSI, Social Security, Rental Income, Worker’s Compensation, Unemployment, Foster Care Subsidy, Alimony, Pensions, Veterans Benefits, Cash Assistance, Dividends/Interest (if over $10/month). Please answer in $. *
Is your current income about the same as your tax return? *
Number of Parent(s)/Parent's spouse in household *
Number of Minor Children in Household *
About your Child *
Yes
No
Receives Birth to Three or Other Special Education Services
Has attended a program before
Is a foster child
What stressors apply to your family?
Any additional comments or concerns about your child or your family situation:
I attest that the information given is true and accurate to the best of my knowledge. Type your name in the box as your electronic signature. *
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Colchester Public Schools. Report Abuse