Preschool Outreach Program (POP) Community Role Model Application for 2024-2025 School Year
Thank you for your interest in the Preschool Outreach Program. 

1. Please submit one application per child. 
2. Be sure to enter correct email and phone number.
3. Once application is submitted electronically, you will receive an email with confirmation of submission. 
4. After the deadline you will receive information from the POP team indicating next steps of the application process. 
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Email *
Today's date *
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Parent/Guardian completing application *
How did you hear about POP *
Child's Name *
Date of Birth *
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Gender  *
Parents/Legal Guardians Names  *
Phone number *
Email *
Address *
Sibling Names and Ages (if no siblings write: none) *
Have any siblings or other family members previously attended POP? *
Are any immediate relatives employed by South Windsor Public Schools? *
What is your child's "home elementary school" (where will your child go to kindergarten)?  *
List all languages spoken in the child's home. *
What was the first language your child learned to speak? *
What language does your child speak most of the time?  *
How would you describe your child's personality? *
How would you describe your child's behavior?  *
What are your child's favorite activities and interests?  *
How long does your child typically spend playing with a favorite toy or activity?  *
Describe your child's strengths. *
Describe any concerns that you have about your child's development. *
List peer-related experiences in which your child participates (i.e. daycare, playgroup, classes). *
Has your child ever received Early Intervention Services (i.e. Birth-to-Three, occupational therapy, physical therapy, speech therapy, etc.)? If yes, please explain. *
READ CAREFULLY: 
Check the tasks that your child can complete independently.
CHECK ALL THAT APPLY
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Required
Check the following behaviors and skills that your child demonstrates.
CHECK ALL THAT APPLY
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Required
Check the following play skills that your child demonstrates.
CHECK ALL THAT APPLY
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Required
Check the following language skills that describe your child.
CHECK ALL THAT APPLY
 *
Required
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