State Funded Registration Request 2021-2022 (Wait List)
Please complete this Registration Request Form to put your child's name on the Wait List for State-Funded/Head Start preschool registration.

Eligibility is based on state and federal income guidelines. Provide us with ALL required information. You may also leave us comments at the end. You will receive an automated confirmation of your submission from Google Docs.

Based on the information you provide through this form, the PUSD Preschool Department will make an appointment for you submit documentation and determine your eligibility for state-funded preschool services. Appointments may be held in person, virtually via Zoom conference or via telephone, depending on current Health and Safety requirements of the County Department of Health.

Please allow for up to 10 business days after completing this form to receive your initial contact from the PUSD Preschool Department.

Email *
Parent First Name *
Parent Last Name *
Phone *
Child's First Name *
Child's Last Name *
Address *
Child's birth date (NOTE: Children must be either 3 or 4 years old on or before 12/1/2021). *
Site - First Choice (choose only one) *
Site - Second Choice (choose any that you would be willing and able to attend)
Total Monthly Income BEFORE taxes from all sources (wages, spousal/child support, cash aid, housing allowance, self-employment income), *
Family Size - How many are living in your household? *
A copy of your responses will be emailed to the address you provided.
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