2023-2024 ULCE Pre K Application
In lieu of completing a paper application, Pre k Applications may be completed by submitting this Google form. After it is submitted, someone will call you to set up a time for the parent or guardian to come to school to sign the application and turn in a copy of the child's Birth Certificate, Social Security Card, Shot record, 2 current proofs of domicile, and 2 current check stubs for each adult in the house OR the SNAP Benefits Detail Report.
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Name of person completing this form *
What is YOUR relationship to the child being registered? *
CHILD'S FIRST, MIDDLE, and LAST name as stated on Birth Certificate *
Child's Birthday *
MM
/
DD
/
YYYY
Child's Gender *
Child's Race: Please mark all that apply *
Required
Is the child Hispanic or Latino *
Address where child is living/residing *
Is this a mailing address? *
Required
If no, what is the mailing address?
List the names of ALL adults (18 and older) living in the house and their RELATIONSHIP to the CHILD (mother, father, grandparent, etc.) *
List the names of OTHER children living in the house and their relationship to the child. If there are none, type NONE *
MOTHER'S FIRST, MIDDLE, and LAST name (biological mother listed on birth certificate) *
Mother's Address (if different from child). If mother lives with the child answer SAME *
Mother's phone number(s) (Must be working number) Home and/or Cell *
Mother's email address (if available)
From BIRTH CERTIFICATE, Father's FIRST, MIDDLE, and LAST name *
ADDRESS of Father listed on the birth certificate. If living with the child answer "SAME"; if you do not know answer "UNKNOWN". *
Father's phone number(s) (Must be working number) Home and/or Cell. If you don't know put "N/A" *
Father's email address (if available)
Name of an Emergency Contact -other than mother and father- Must be 18 or older *
Emergency Contact's Address *
Emergency contact phone number *
Emergency contact relationship to child *
Is the child a foster child? *
Is English the child's primary language? *
Does the child receive Special Education Services (IEP) *
Does the child receive Speech Services? *
Does the child receive Early Intervention services (IFSP)? *
Has the child been referred by Psychological Services? *
Does the child have a suspected disability? *
If yes, what is the disability
Is the child's address a temporary living arrangement? *
If you answered yes, is it temporary due to loss of housing or economic hardship?
Clear selection
If yes, which best describes your situation?
Clear selection
Are you renting? *
With whom is the child residing/ living? Select all that applies *
Required
Does the parent/guardian have the child's BIRTH CERTIFICATE? *
Does the parent/guardian have the child's Social Security Card? *
Does the parent/guardian have the child's Shot Record? *
Which documents do you have for Proof of Income? *
Which bills are CURRENT and available in the Mother, Father, or LEGAL guardian's name for the address at which the child lives? Check all that apply *
Required
List a WORKING PHONE NUMBER which you may be reached to schedule a time to sign the application and turn in ALL required documents *
Submit
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