USD 270, Plainville - Preschool Assessment Form (KPP)
This is EXTREMELY IMPORTANT for funding purposes as we utilize federal and state grant money.  All information will be kept strictly confidential.  This information is a requirement for the program.
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Email *
Child's First & Last Name *
Date of Birth *
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Mother's First & Last Name
Father's First & Last Name
How old will your child be on or before August 31, 2020? *
Level of mother's education?
Level of father's education?
At the time of enrollment, does the mother have a HS diploma or GED?
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At the time of enrollment, does the father have a HS diploma or GED?
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My child qualifies for the free lunch program. (If yes, a copy of the approved form that was validated by the food service secretary must be submitted to the office.  This MUST be completed again at enrollment time and be valid on 09/20/20.) *
My child comes from a single parent household. *
At least one parent was a teen when the child was born. *
If yes above, list the parent's first and last name.  (If you answered No, enter NA) *
If yes, list the parent's date of birth.  (If you answered No, enter NA) *
Is English the primary language in the home? *
Are you enrolled in a migrant program? *
By entering my name below, I verify that all information given is correct and accurate. I understand that entering my name serves as an electronic signature.
First & Last Name of parent filling out this form *
Today's Date *
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