KIDSTART

REGISTRATION FORM

To qualify you will need to meet at least one of the following criteria:

Poverty - the child is eligible for free lunch
Single-Parent Families - custodial parent is unmarried at time of enrollment
Teen Parent(s) - one parent was 13-19 years old at the time of the child's birth
One parent lacking a high school diploma or GED certificate
Limited English proficiency - a child whose "first" language is other than English
Children qualifying for migrant status - a copy of the Certificate of Eligibility must be on file
SRS Referral - a written referral from Social Rehabilitative Services documented with a copy in the student's file
Developmentally or academically delayed - documentation of a child's identified delay(s) must be on record based on valid and reliable assessments.

*Children with multiple "at risk" criteria will receive priority consideration for enrollment.
**Special Education students are not eligible for this program.

The preschool program will meet 4 days a week with the children and one evening a month with both children and parents.  Parent participation at the evening sessions is required.  Each family will receive 2 home visits during the year.

Parent Name:

Address: 

Home Phone:

Daytime Phone:

Child's Name: 

Male
Female

Date of Birth