2021-2022 ECEC Preschool Lottery Application
Please refer to the Preschool Lottery Information Sheet on our website before submitting this lottery application. Please refer to our website at www. dedham.k12.ma.us for further information.
Email address *
ECEC Preschool 2021-2022
Student (Applicant) Information:
Child's Last Name *
Child's First Name *
Child's Date of Birth *
MM
/
DD
/
YYYY
Gender *
Home address: *
Mailing address (if different)
Parent/Guardian Information
Parent/Guardian #1 Name (Last, First) *
Parent/Guardian #1 Address (write same if applicable) *
Parent/Guardian #1 Telephone Number *
Parent/Guardian #1 Email address *
Parent/Guardian #2 Name (Last, First) *
Parent/Guardian #2 Address (write same if applicable) *
Parent/Guardian #2 Telephone Number *
Parent/Guardian #2 Email address *
General Information about your child
Does your child currently attend Preschool? *
If yes, where does your child attend Preschool?
Is your child toilet trained? (Typically developing students must be toilet-trained in order to be considered) *
Has your child had any serious illnesses? *
Has your child had Early Intervention Services? If so, for what? (write N/A if not applicable) If yes, What agency provided these services? *
3 year old Class Preference
Please indicate your class preferences by indicating your 1st & 2nd choice. Students MUST be 3 years of age by September 1st.
(3 yr. old) First Choice
(3 yr. old) Second Choice
4 year Class Preference
Please indicate your class preferences by indicating your 1st & 2nd choice. Students MUST be 4 years of age by September 1st.
(4 yr. old) First Choice
(4 yr. old) Second Choice
A copy of your responses will be emailed to the address you provided.
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