Preschool Screening Interest Form
Please complete this form if you are interested in your child attending one of Komarek 94's free developmental screenings for preschool-age students. 

Komarek School District offers preschool screening three times per year - fall, winter, and spring. The screening process will help tell you how your child is developing. Assessed areas include speech and language, pre-academic skills, large and small muscle skills, social/emotional development, and hearing/vision.

(Parents of twins: Please put information for both students in one form - no need to complete the form twice)

To begin, please enter your email address below:

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Email *
Primary Parent Contact: First and Last Name *
Primary Parent Contact: Preferred Phone Number *
Primary Parent: Language of Communication *
What language do you speak to your child in? *
Student: First and Last Name *
Student: Birthdate *
MM
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DD
/
YYYY
Student: Home Address *
Do you have any specific concerns that you would like addressed through this screening? (Please answer Yes/No - if yes, describe your concerns) *
Thank you for expressing your interest in preschool screening! A Komarek staff member will reach out to you a few weeks before the next preschool screening to schedule a screening appointment for you and your child. Please make sure to hit 'Submit' below.
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