Child's Full Name (First, Middle, Last): | Name child prefers in the classroom: |
Child's Date of Birth (MM/DD/YYYY) / / | Male/Female: |
Is any other langauge other than English Spoken in the home? | If yes, please list the other languages: |
Parent/Guardian Name: | |
Home Address: | |
Home Phone Number (With area code): | Cell Phone Number (With area code): |
E-mail Address: | |
Number of adults living in the home: | Number of children living in the home: |
Names and ages of all children living in the home: | |
Parent/Guardian Place of Employment Mother/Guardian 1: | Father/Guardian 2: |
Please list any specific needs your child has that you feel this program will meet. | Who referred your child to our program? |
Based on state guidelines, the Buena Vista Preschool Initiative class will serve a limited number of four-year-old students based on identified risk factors. Risk factors include:
- Family income
- Level of parent education
- Family stressors such as chronic illness, homeless, etc.
If you believe your child may qualify, please complete the pre-application online form or print out this form and return it to Kling Elementary School. There is also limited space for students who do not meet the above qualifications. Once you complete this application, you will be contacted to complete a screening process in April.
The preschool program will be housed at Kling Elementary School and will follow the Buena Vista City Schools calendar.
Transportation and snacks are provided daily for students.
Timeline
Application review will begin March 1
Screenings will be held in April and May
Parents will be notified of enrollment by June 15
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