Moffat County School District           Preschool Application
This application is for three and four year olds who are three prior to August 31st.  Please complete the first half of the application if you plan to pay tuition or your child will attend a half day program and is on an individualized education plan (IEP).  The entire application should be completed if you would like to apply for a Colorado Preschool Program Scholarship.  Eligibility for this scholarship will be determined by the information you provide on the second part of this application.  All families applying for their child to attend full day preschool should complete the entire application unless planning to pay tuition.  Tuition is $250 for a half day of preschool and $400 for a full day.
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Today's date *
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Child's Name *
Name Child goes by:
Child's Birth date *
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Gender *
Allergies/Conditions
Does your child have any siblings?  If so, please list names and ages.
Is this your Child's first preschool experience? *
If this is not their first preschool experience, where did they attend?
I have concerns about my child's development.  Mark all that apply
If applicable, where is your child receiving services for these concerns?
Would you prefer *
For program planning purposes please indicate a choice of time.  These times are subject to change. *
Does your child speak a language other than English? *
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