2017-2018 Riceville CSD Preschool Application Form
Eligible preschoolers must be four years old prior to September 15, 2017.
Please fill out the information below and click the submit button.
**Submission of information does not guarantee enrollment in Riceville CSD Program, families will be notified if their child is accepted.
Child's Information
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Middle Name
Your answer
Child's Birth Date
MM
/
DD
/
YYYY
Child's Gender
Ethnicity
Race
Language Spoken
Session Preference
Required
Drop off/Pick up
Parent/Guardian Information
Parent/Guardian 1 Last Name
Your answer
Parent/Guardian 1 First Name
Your answer
Parent/Guardian 1 Relationship to Child
Parent/Guardian 2 Last Name
Your answer
Parent/Guardian 2 First Name
Your answer
Parent/Guardian 2 Relationship to Child
The State Preschool Grant requires that Riceville CSD request the following information
Please check any service(s) that you are currently receiving
Contact Information
Primary Phone
Your answer
Parent/Guardian 1 Email Address
Your answer
Parent/Guardian 2 Primary Phone Number
Your answer
Parent/Guardian 2 Email Address
Your answer
Address Information
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Submit
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