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Documentation �Checklist (Page 1 of 2)

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To ensure compliance with the requirements of our funder, California Department of Education, we must verify eligibility of each family participating in the Part-Day State Preschool Program. Please submit the following documents:

ELIGIBILITY VERIFICATION Documentation must be provided for 1 or more of these eligibility categories

Recipient of Child Protective Services or Child Identified as At-Risk

  • Referral Letter

Family Experiencing Homelessness

  • Self-Certification of Income AND
  • Referral Letter OR
  • Parental Declaration of Homelessness

Child with Disabilities

  • Self-Certification of Income AND
  • Individual Family Services Plan (IFSP) OR
  • Individualized Education Program (IEP)

Approved Neighborhood �School Boundary

  • Self-Certification of Income AND
  • Verification of Home Address (Example: Utility bill | Property tax bill | Voter registration | Rental/lease agreement | Government agency letter | Pay stub)

Receiving Benefits from Governmental Program�CalWORKs, Medi-Cal, CalFresh, California Food Assistance, California Special Supplemental Nutrition Program for Women, Infants and Children (WIC), Food Distribution Program on Indian Reservation, Head Start or Early Head Start.

  • Enrollment Documentation (Example: Notice of Action | Receipt of Aid | Verification of Benefits) AND
  • Copy of Governmental Program Application OR
  • If not available, Self-Declaration of Income as declared on the program application

Income Eligibility

Guardian or Foster Parent(s):

  • Documentation of Monthly Income (For child and their related siblings)

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Biological or Adopted Parent(s):

  • Authorization to Release Employment Information (if applicable) AND
  • Parent Notification: Requirement to Report Income Over Threshold
  • Documentation of Monthly Income (ALL sources for ALL parents in family)

Regular & Steady Income: Total countable income from either month of the 2-month window immediately preceding certification

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Fluctuating or Inconsistent Income: Total countable income from 12 months immediately preceding certification

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Documentation �Checklist (Page 2 of 2)

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FAMILY SIZE and PRESCHOOL AGE VERIFICATION

At least 1 of the following documents must be provided for ALL children counted in family size:

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  • Birth Certificate or other live birth records
  • Passport for Services from the county welfare department
  • Adoption documents Records of Foster Care placement
  • Court orders regarding child custody or guardianship

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RESIDENCY VERIFICATION �Proof that you live in the State of California:

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  • Any evidence of your street address or post office box dated within the past 30 days

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CHILD CARE LICENSING DOCUMENTS | FORMS�If approved, ALL of the following documents/forms are required prior to first day of school:

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  • Copy of child’s current immunization record
  • Identification & Emergency Information
  • Child’s Preadmission Health History – Parent/Authorized Representative Report (LIC 702)
  • Physician’s Report (LIC 701)
  • Notification of Parents’ Rights (LIC 995)
  • Personal Rights (LIC 613A)
  • Consent for Emergency Medical Treatment (LIC 627)

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OTHER DOCUMENTATION�The following miscellaneous documents are also required:

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  • Family Needs Request & Referral
  • Family Language Instrument
  • Court orders if they affect your child care days/hours (If applicable)

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Submitting�Documents

Thank you for your interest in our Part-Day State Preschool program.

PROCESS TO SUBMIT DOCUMENTATION:

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  1. Create a Hubbe accounts using an email and password (Hubbe Link)
  2. Complete each section of the application. Submit forms AND copies of required documentation listed on checklist in your portal account by uploading them
  3. Sign and submit application once all required documentation has been uploaded

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NOTE: Carefully review checklist located at the beginning of this packet to ensure all required documentation is submitted. Incomplete packets will delay the enrollment process. All forms are available on the Hubbe platform.

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If you have any questions about the

enrollment process please contact our

office at (916) 375-7600 x 1311 or by email at moropeza@wusd.k12.ca.us

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Washington Unified School District

930 Westacre Road

West Sacramento, CA 95691

www.wusd.k12.ca.us

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