Universal Pre-K (UPK) Program 2024-2025 Application

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Child must be 4 years old on or before December 1, 2024 and can live in ANY school district.

Children eligible to attend Kindergarten are not eligible for UPK.

The 5 hour a day, 5 day/week UPK Program is New York State funded. Income is not a factor. All families eligible are encouraged to apply.

Parents/Caregivers are responsible for transportation.

Tuition-based Aftercare may be available.

Date: *

YYYY

Child's Name: (First and Last Name)
*

Date of Birth: *

YYYY

School District child resides in: *

Caregiver/Guardian #1: (First and Last Name) *

Caregiver/Guardian #2: (First and Last Name)

Child's Address: (Street, City, State, Zip Code) *

Telephone Number: (cell, home, work) *

Email Address: *

Does the child receive Special Education Services? *

Yes

Required

If yes; what services does your child receive?

Speech/Language Therapy

Occupational Therapy

Physical Therapy

Special Education Itinerant Teacher (SEIT)

Other

Is English the primary language spoke in the home: *

Yes

What other languages are spoke at home:

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