* 1. Please provide

* 2. PLEASE INDICATE YOUR 1ST AND 2ND PREFERENCE OF LOCATION AND REASON.

  1st Choice 2nd Choice
Arthur (NE)
Cleveland (NW)
Coolidge (SW)
Grant Wood (SE)
Harrison (NW)
Hoover (NW)
Jackson (NW)
Kenwood (NE)
Nixon (Hiawatha)
Taylor (SW)
Viola Gibson (NE)
Wright (NE)

* 3. REASON:

* 4. PLEASE INDICATE SESSION PREFERENCE. ALL SESSIONS MEET MONDAY, TUESDAY, WEDNESDAY AND THURSDAY.

* 5. Preschool Family Information (required):

* 6. Preschool Family Information (optional):

Shared Visions Funding Information – If you think any of the following criteria pertains to your child, please complete.

* 7. Do you have documentation that your child is functioning below developmental levels in:

  Yes No
English Proficiency?
Physical Development?
Cognitive/Language Development?
Social/Emotional Development?
Was your child born with a low birth weight?
Was your child born with a medical disorder?

* 8. INCOME STATUS (check all that apply)

* 9. CHILD/FAMILY NEEDS (check all that apply)

* 10. Please review the following requirements and then enter your name in the box below.

Enrollment for your child will only be considered when all forms listed below are completed and on file in the Early Learning office. This includes:
• Child’s birth certificate
• Family income verification (if the family feels they would be eligible)
• District Enrollment Form
• District Home Language Survey
• Online Preschool Registration Form

By typing in your name below you are acknowledging that you understand the requirements for full enrollment.

Thank You for completing the preschool registration form.

CLICK THE DONE BUTTON NOW.

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