APPLICATION for consideration in USD 417 Pre-K
*Please answer each question. Completion of the application determines your child's eligibility for the program.
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Email *
Child's First and Last Name *
Child's Date of Birth *
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DD
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YYYY
Parent/ Guardian Names for Child *
Child's Home Address *
Phone number that you can be reached at *
Email Address that you can be reached at. *
1. How many people are in your household? *
2. What is your annual income? *
3. My child will be 4 years of age on or before August 31 of this year. *
4. My child lives in a single (unmarried) parent household at this time. *
5. At least one parent was a teenager when the child was born. *
6. Is the child's current address a temporary living arrangement? *
7. If you selected yes to question 6, please check at least one of the following. If you selected no, please check N/A. *
Required
8. One parent lacks a high school diploma or GED certificate. *
9. A language other than English is spoken in the home or was my child’s first language. *
10. My child currently has an IEP for Special Education services. *
11. If you selected yes to question 10, please check at least one of the following. If you selected no, please check N/A. *
Required
At time of enrollment, my child has health care. *
My child is potty trained.  *
PreK teachers will be reaching out to you at the end of the school year to determine placement. Placement will be determined based on the following prioritized criteria:
1. Completed Application (no areas left blank)
2. State of Kansas PreK Funding Criteria
3. PreK Screening Scores
4. Teacher Discretion
Which section would be your top choice? *
After you submit this application, please call USD 417 CGES Office at 620-767-6851 to schedule an appointment
1. PreK Screening: Thursday, March 23 and Friday, March 24
2. Birth to Age 3 screening Thursday, March 23 only
3 Screenings will be at Council Grove Elementary, enter SE Door of PreK Building on 8th Street
4. All students must be potty trained before enrollment for PreK.
5. PreK families of students (who will be 4 by September 1, 2022) please bring:
             *current physical form (within the past year),
             *immunization records, certified birth certificate.
             *These forms are required for school entry.
6. We ask that only the child/children being screened and one parent attend at their scheduled time.   
7.  All PreK students must complete screening to attend school..


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