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Preschool Eligibility Questionnaire 24-25
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Child's First and Last Name
Your answer
Child's DOB (Must turn 3 by December 1st, 2024)
Your answer
Physical Address (Proof of residency will be required)
Your answer
Which program are you interested in?
Part Day 8:15am - 12:00pm 5 days a week
Full Day 8:00am - 4:30pm 5 days a week
Other
Clear selection
How many adults & children living in the home (not including grandparents)?
Your answer
Monthly income for household (before tax deductions)
Your answer
Do you have other children enrolled in Marcum-Illinois School?
Yes
No
Clear selection
Is anyone in your household certified to receive benefits from Medi-Cal, CalFresh, WIC or CalWORKS?
Yes
No
Other:
Clear selection
Is your family currently experiencing homelessness?
Yes
No
Clear selection
Is the child a foster child?
Yes
No
Clear selection
Has the child been diagnosed with a disability and have a current (IFSP) Individual Family Service Plan or (IEP) Individualized Educational Plan?
Yes
No
Clear selection
Is the child potty trained?
Yes
Mostly (needs reminders, has occasional accidents)
Not Yet
Clear selection
Contact Email
Your answer
Contact Phone Number
Your answer
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