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UCS Great Start Readiness Program Pre-Application
Children must be 4 years old on or before September 1
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* Indicates required question
Date of Application (today's date)
*
MM
/
DD
/
YYYY
Child's Last Name
*
Your answer
Child's First Name
*
Your answer
Child's Gender
*
Girl
Boy
Child's Date of Birth
*
MM
/
DD
/
YYYY
With whom does the child reside?
*
Mother
Father
Both Parents
Legal Guardian
Foster Care
Other:
Child's Home Address (Example) 123 School Rd.
*
Your answer
City
*
Your answer
Zip Code
*
Your answer
Do you live in the Utica Community School District
*
Yes
No
No, but we are a School of Choice family
What is your UCS Home School? (The elementary school in which your child will attend Kindergarten)
*
Your answer
Family Email Address
*
Your answer
Mother's Name (Last Name, First Name)
*
Your answer
Mother's Address (if not the same as the child's)
Your answer
Mother's Phone #
*
Your answer
Mother's Marital Status
*
Choose
Married
Single
Divorced
Widowed
Seperated
Father's Name (Last Name, First Name)
*
Your answer
Father's Address (if not the same as the child's)
Your answer
Father's Phone #
*
Your answer
Father's Marital Status
*
Choose
Married
Single
Divorced
Widowed
Seperated
Total number of people living in household (Including Student)
*
Your answer
Annual Household Income (before deductions, last 12 months) Include all persons living in household (1040, W-2, DHS, Soc Sec., Child Support)
*
Your answer
Have you applied for/or is your child on a waitlist for Head Start?
*
Yes
No
Are there any other factors that you think may qualify you for the GSRP program?
Your answer
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