USD 423 Preschool Pre-enrollment Request

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If you are interested in having your child participate in the Moundridge Elementary School Preschool program for the 2022-23 school year, please complete this pre-enrollment form. USD 423 offers both a 3-year-old and 4-year-old program. Completion of this form does not guarantee a spot in our program, however, this is the first step in applying. You will be notified by the school with an enrollment determination for the fall.

Things to know:
Your child must be 3 or 4 by August 31, 2022 to be eligible to attend.
Tuition is $75.00 per month September - May.
Families meeting one or more of the at-risk guidelines listed below qualify for free tuition.
Students must be potty trained to attend our program.
Our preschool program runs four half-days per week (Mon. Tues. Thurs. and Fri.) Children are expected to participate in all four sessions each week.
Upon acceptance, a $50 non-refundable fee is required to hold a spot for your child. Checks can be made out to Moundridge Elementary School and must be submitted by Friday, May 20th to hold your child's spot. Please do not submit a check until you receive an acceptance letter from the school.

Thank you for your interest in our preschool program!
USD 423

Email *

Child's First Name *

Child's Last Name *

Child's Date of Birth *

YYYY

Child's Gender *

Male

Female

Child's Anticipated Class *

Mother's Name *

Father's Name *

Primary Mailing Address *

City *

Secondary Mailing Address *

City *

Primary Phone number and Contact Name

Secondary Phone number & Contact Name *

Does your child currently have an IEP (Individualized Education Plan)? If yes, please type "Yes" AND specify for which services. If no, please type "No." *

In order to qualify for free tuition, your child must meet one of the following at-risk criteria. (Note: some additional information may be required of you in order to verify the criterion.) Please check all that apply. This information will be kept confidential. *

Qualify for free tuition and lunch status based on income guidelines or categorical eligibility from the the Federal Lunch Program Application (Application required) (In the next question, please provide your yearly income and the number of people living in your home. If you qualify based on categorical eligibility, please provide your case number.)

Single Parent Household (custodial parent is unmarried on the first day of school) (Please provide the name of the single parent in next question.)

Foster Care/Grandparents or Kinship Care/Out-of-Home Placement (Child is in foster care, custodial gradparents/kinship care, or out-of-home placement at the time of enrollment.)

Teenage parent at the time of the child's birth At least one parent was a teenager - 19 or younger - at time of child's birth) (Please provide the Mother's date of birth and age at the child's birth and/or the Father's date of birth and age at the child's birth.)

Parent(s) do not hold a high school diploma or GED (Please provide the highest grade level completed for both the mother and father.)

Limited English Proficiency - another language is primarily spoken in the home (Please indicate the primary language spoken in the home.)

Child has lower than expected developmental progress in one of the following areas: cognitive; physical; communication/literacy; social-emotional-behaviora; adaptive behavior/self-help skills (Based on results of a valid assessment given by the school)

A DCF referral that describes the child's need to attend a Pre-k program. The referral must be signed by the DCF agent and a copy provided for the school.

Child qualifies for migrant status (Copy of Certificate of Eligibility must be on file)

Child is experiencing chronic or episodic homelessness

Child is lacking health insurance (At the time of enrollment, child has no health insurance coverage.)

None of the above apply to my child

Required

Federal Income Guidelines for Fiscal Year 2021-22 (Please note these numbers will likely change for Fiscal Year 22-23, yet this will give you a close estimation of income guidelines.)

If you selected any of the above at-risk qualifications, please provide the specific additional information requested here.

Does your child attend Cradles 2 Crayons? *

Yes

Will your child need transportation to and from Cradles 2 Crayons? *

Yes

Would you like your child to ride a school bus to school (A.M. students only) or from school (P.M. students only)? Please note that this is only an option for students who live 2 or more miles from the school. Parents must provide mid-day transportation. *

Yes

Is your child potty trained or will he/she likely be by September? *

Yes

Maybe

Has your child attended any other preschool? If yes, please indicate which preschool and for how long.

Do you have a time preference? (Please understand this cannot be guaranteed, but will be considered if possilbe.) *

Either

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