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Early Childhood Scholarship Application
Westminster Public Schools receives funding from the State of Colorado to fund Preschool and Kindergarten programs in our district. This application helps us determine which students meet the criteria for state-approved risk factors to receive funding. All students in preschool and kindergarten programs within WPS are required to submit an application.
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* Indicates required question
Student First Name
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Your answer
Student Last Name
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Your answer
Student Date of Birth
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MM
/
DD
/
YYYY
Please select the program you have applied for:
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Half Day Preschool
Full Day Preschool Lottery
Kindergarten
Please select your neighborhood school:
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Choose
Early Childhood Center
Fairview Elementary School
Flynn Elementary School
F.M. Day Elementary School
Harris Park Elementary School
Hodgkins Elementary School
Mesa Elementary School
Metz Elementary School
Sherrelwood Elementary School
Skyline Vista Elementary School
Sunset Ridge Elementary School
Tennyson Knolls Elementary School
Westminster Academy for International Studies
Colorado STEM Academy
Please select your schedule preference for half day preschool:
Morning session 8:00am - 11:00am
Afternoon session 12:00pm - 3:00pm
No Preference
What is your family's monthly income (before taxes):
*
Your answer
How many people live in your home?
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Your answer
Does your child reside with parent(s)/guardian(s)?
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Yes
No
Parent/Guardian #1 Name:
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Your answer
Parent/Guardian #1 Age at birth of child:
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Under 18 years old
Over 18 years old
Parent/Guardian #1 education:
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High School Diploma or GED
Did not graduate High School or get GED
Is this a single parent household? If yes, skip questions for Parent/Guardian #2
*
Yes
No
Parent/Guardian #2 Name:
Your answer
Parent/Guardian #2 Age at birth of child:
Under 18 years old
Over 18 years old
Clear selection
Parent/Guardian #2 education:
High School Diploma or GED
Did not graduate High School or get GED
Clear selection
Is there or has there been an abusive adult residing in the home?
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No
Yes
Is there or has there been drug or alcohol abuse in the home where the child lives?
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No
Yes
Has your child moved frequently?
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Less than 2 times in the last 4 years
More than 2 times in the last 4 years
Is or has your child been receiving services from the State Department of Social Services related to neglect or abuse?
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No
Yes
Has your child attended school before?
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No
Yes
Has your child or immediate family members received Special Education Services? If yes, please explain below.
Your answer
Is your child in need of language development including, but not limited to, the ability to speak English? If yes, please explain below.
Your answer
Do you have emotional/behavioral concerns about your child? If yes, please explain below
Your answer
Does your child have problems with social situations? If yes, please explain below.
Your answer
Has your child had any serious illness or medical diagnosis? If yes, please explain below.
Your answer
Has your child had any special evaluations, tests, exams, screenings or therapy? If yes, please explain below.
Your answer
Is there any additional information you would like to share that may assist our staff to determine eligibility?
Your answer
The information on this form is correct to the best of my knowledge. (type name)
*
Your answer
Date filled out:
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MM
/
DD
/
YYYY
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