"Unofficial" ESA Grant Eligibility Form (English)

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SY 2024-2025

We are in the process of reapproval for the state grant and won't find out of approved grant spots until June 2024. Updated January 5, 2024
State of Utah, Department of Workforce Services, Office of Childcare
Disclaimer: Filling out this grant eligibility application does not automatically guarantee acceptance nor enrollment into ICSD Preschool's Program.

Email *

Child's Name *

Date of Birth *

YYYY

Parent(s) Name *

Physical Address (school boundary indicator) *

Phone Number *

Boundary School *

South Preschool (638 W 500 S, Cedar City)

Three Peaks Preschool (1521 Midvalley Road, Enoch)

Escalante Valley Elementary Preschool (202 N Beryl Hwy, Beryl)

Is the student eligible for Kindergarten (5 years-old on or before September 1st, 2023)? *

*If you selected no, please continue to complete the form*

Yes

Is the student an English Learner (learning English as a second language)? *

Yes

I don't know

Is the student currently in Foster Care?

Yes

I don't know

Clear selection

Is the student eligible for free or reduced lunch? *

Yes

I don't know

Select the number range of Risk Factors that apply to your child: *

1-2

3-5

6-8

9-10

11-12

Affirmation: I certify that the above information is true and accurate to the best of my knowledge. *

Yes

Disclaimer: Filling out this grant eligibility application does not automatically guarantee acceptance nor enrollment into ICSD Preschool's Program. *

I understand

Parent Signature *

Typing your name will act as an electronic signature

Date *

YYYY

Submit

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