UCS GSRP Pre-Application 2018-19 School Year
Children must be 4 years old on or before December 1, 2018 and toilet trained
Date of Application *
Today's Date
MM
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DD
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YYYY
Child's Last Name *
Your answer
Child's First Name *
Your answer
Child's Gender *
Required
Child's Date of Birth *
Children must be 4 years old on or before December 1, 2017
MM
/
DD
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YYYY
With whom does the child reside? *
Child's Home Address *
(Example) 123 School Rd.
Your answer
City *
Your answer
Zip Code *
Your answer
Do you live in the Utica Community School District? *
Required
What is your UCS Home School? *
The elementary school in which your child will attend Kindergarten
Your answer
Mother's Name
Last Name, First Name
Your answer
Mother's Address
If not child's address
Your answer
Mother's Phone # *
best number to be reached
Your answer
Mother's Marital Status
Father's Name
Last Name, First Name
Your answer
Father's Address
If not child's address
Your answer
Father's Phone # *
best number to be reached
Your answer
Father's Marital Status
Total number of people living in household *
Including Student
Your answer
Annual Household Income (before deductions, last 12 months) *
Include all persons living in household (1040, W-2, DHS, Soc Sec., Child Support)
Your answer
Have you applied for; or is your child on a waitlist for Head Start? *
Are there any other factors that you think may qualify you for the GSRP program?
Your answer
Family Email Address *
Your answer
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