VT Act 166 Universal Prekindergarten Funding Application and Residence Affidavit for Resident WCSU District Students
This is a Universal Prekindergarten application for funding. This form applies to residents of Barnard, Bridgewater, Killington, Pittsfield, Plymouth, Pomfret, Reading, or Woodstock who are the parent or guardian of a child ages 3 or 4 years old on or before September 1st, 2019.
Your email address: *
Child's First Name: *
Child's Last Name: *
Child's Date of Birth: *
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Child's Gender *
Child's race/ethnicity (check all that apply): *
Required
Is your child eligible for (check all that apply):
Language(s) other than English spoken in the home:
Child's MAILING Address: *
Child's MAILING Town/State/ZIP *
Child's PHYSICAL STREET Address (if different from mailing address):
Child's Legal Town of Residence (may differ from MAILING town): *
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Name of VT Prequalified Prekindergarten Program you would like to enroll your child in: *
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My child is: *
MOTHER'S (or guardian's) first and last name: *
MOTHER'S (or guardian's) phone number: *
FATHER'S (or guardian's) first and last name: *
FATHER'S (or guardian's) phone number: *
Are the parents divorced? *
Required
If divorced, date of divorce decree:
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Child lives with: *
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Affidavit of Pupil Residency for NEW students or those re-enrolling AFTER WITHDRAWAL
Parents, legal guardians, and custodians of pupils enrolling in any of the individual school districts for the first time, re-enrolling after withdrawal, or whose residence is being questioned, must supply one document from EACH of the following areas. These documents are for address verification and must all reflect the address provided for enrollment or change of address. If you are not attaching the documents please state the reason below. Otherwise, please attach the documents.
Verification of Residency
WCSU is responsible for ensuring the education of pupils who reside in their towns. In addition, the school boards have a responsibility to the taxpayers of these towns to be assured that the Districts are only educating those pupils whose parents, legal guardians, or custodians have chosen to make the Districts their residence, or who meet the statutory exceptions to the residency requirement. Accordingly, the individual Districts may, consistent with state statute, refuse to accept or may dismiss pupils who are not legal residents of the District.

In order to determine whether a pupil is a legal resident as defined by Vermont Law, the Districts require proof of residency as described below.

Please attach ONE of these items: copy of deed or record of most recent mortgage statement; or copy of current lease; or notarized letter from landlord confirming tenancy; or current tax bill.
Please attach ONE utility bill or work order dated within the past 30 days, including: water bill, electric bill, telephone bill, cable bill.
Please attach ONE of these items: valid Vermont Driver's License, current vehicle registration, bank statement (financials withheld), voter registration.
I am not providing these documents because:
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