Lansing Early Childhood Pre-Kindergarten and Preschool Application 2024-2025 School Year

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For office use only:
Date Received: _______________________. Time Received: _______________________.

Program if Eligible:____________________. AM or PM:____________________________.

Not Eligible Reason: _________________________________________________________________.

Student Legal Name: *

Student Date of Birth: *

YYYY

Student Gender: *

Male

Female

Prefer not to say.

What School District you live in? *

List any other agencies/schools that have been involved/are currently involved with your child. *

Parent/Guardian #1 Name: *

Place of Employment *

Address: *

Phone Number(s): *

Email Address: *

What is your preferred method of communication: *

E-mail

Phone

US Postal Service

Other:

Parent/Guardian #2 Name:

Place of Employment *

Address:

Phone Number(s): *

Email Address:

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