HIPPY Application 2020-2021
Requirements for application:  Students must be 2, 3 or 4 on or before September 1, 2020.  Students MUST reside within the Madison City School district.  A Preschool Readiness Assessment will be given to all students and acceptance into the program is based on academic need.

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Child's First and Last Name *
Child's Date of Birth *
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DD
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Gender *
Parent/Guardian Name(s) *
Address (including city and zip) *
Email address *
Race
Primary Language *
Phone Number *
Check all services that you qualify for: *
Required
Which elementary school is your child currently zoned for?
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Please list any private programs your child has previously attended or is participating in at this time. *
Does your child receive Special Education Services or do you suspect a disability? *
I understand that if my child is selected I will need to complete an additional enrollment package.  Type name below as signature & understanding of requirements. *
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