GSRP Application
Please fill this form out completely. An Imlay City GSRP staff member will contact you to set up a follow-up appointment to go over income and eligibility factors. This application is not considered complete until all documentation is turned in and an in-person interview is completed.

Please note that GSRP is not a first come, first serve program. All applications and documentation is collected and eligibility is based on income and greatest educational need according to eligibility factors. Because this is a state-funded preschool program, we cannot enroll students into GSRP until the Governor releases funds. This typically happens in August.

PLEASE NOTE: There is NOT AN OPTION TO SAVE this application and go back into it later. You will want to make sure you have the following information available when you fill out the application:
*Child's doctor's name and phone number
*Name and phone number for at least one emergency contact

Email address *
Child's Full Name *
First, Middle, Last
Your answer
Will your child be 4 years old on December 1, 2019? *
Please note that children who turn 4 September 2 - December 1, 2019 will qualify for our second round of enrollment, if there are still slots available on 10/1/2019.
Date of Birth *
MM
/
DD
/
YYYY
Gender *
Child's Home Address *
Number, Road, City, State, Zip
Your answer
County of Residence *
Home School District *
ISD
Primary Phone *
Your answer
Secondary Phone *
Your answer
How many people are in your family? *
Adults & Children
Your answer
What was your 2018 total family income? *
*As reported on taxes. (Proof of income will be verified, in person, at Preschool Registration.)
Your answer
Birth Father's Name *
First & Last
Your answer
Birth Mother's Name *
First & Last
Your answer
Birth Parents are *
Child lives with *
Please check all that apply.
Required
Where does child stay at night? *
Race *
Hispanic or Latino *
Primary Language *
Does your family migrate? *
If yes, approximate dates of migration?
Your answer
Father/Legal Guardian
Father/Legal Guardian's Name *
If not applicable, please write N/A
Your answer
Father/Legal Guardian's Date of Birth *
If not applicable, please write N/A
Your answer
Father/Legal Guardian's Relation to Child *
Father/Legal Guardian's Education Level *
Check highest achieved.
Father/Legal Guardian is Employed *
Father/Legal Guardian is in School/Job Training *
Mother/Legal Guardian
Mother/Legal Guardian's Name *
If not applicable, please write N/A
Your answer
Mother/Legal Guardian's Date of Birth *
If not applicable, please write N/A
Your answer
Mother/Legal Guardian's Relation to Child *
Mother/Legal Guardian's Education Level *
Check highest achieved.
Mother/Legal Guardian is Employed *
Mother/Legal Guardian is in School/Job Training *
Is mother currently pregnant? *
List first and last name and birth date of others in household supported by income of parent/guardian(s)
Dependent #1 Name
First & Last
Your answer
Dependent #1 Date of Birth
MM
/
DD
/
YYYY
Dependent #2 Name
First & Last
Your answer
Dependent #2 Date of Birth
MM
/
DD
/
YYYY
Dependent #3 Name
First & Last
Your answer
Dependent #3 Date of Birth
MM
/
DD
/
YYYY
Dependent #4 Name
First & Last
Your answer
Dependent #4 Date of Birth
MM
/
DD
/
YYYY
Dependent #5 Name
First & Last
Your answer
Dependent #5 Date of Birth
MM
/
DD
/
YYYY
Dependent #6 Name
First & Last
Your answer
Dependent #6 Date of Birth
MM
/
DD
/
YYYY
Alternate Contact Name *
Your answer
Alternate Contact Phone *
Your answer
Active US Military *
US Military Veteran *
Referred by a Child Welfare Agency *
SNAP *
WIC *
Next
Never submit passwords through Google Forms.
This form was created inside of Imlay City Schools. Report Abuse - Terms of Service