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Early Learning Interest Form
Thank you for your interest in Oak Harbor Public School’s Early Learning Programs! Please complete this pre-application to help us determine the eligibility of your child in one of our Early Learning Programs.
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Child's Name
Your answer
Birthdate of Child
MM
/
DD
/
YYYY
Parent/Guardian Name
Your answer
Address
Your answer
Phone
Your answer
Email
Your answer
This child was previously enrolled in (check all that apply)
Early Head Start
Head Start, ECEAP, or Transitional Kindergarten
Head Start, Migrant Head Start or ECEAP with a different agency
Any birth to three visiting program
Child Development Center
Private Child Care or Preschool Program
Hand in Hand
No previous preschool experience
Name of the Preschool (if applicable)
Your answer
Is your child on an Individualized Education Program (IEP)? Or receive Early Intervention Services?
Yes
No
Clear selection
If no, do you currently have concerns about your child's development?
Your answer
Is this child in official foster care? (This means there is a caregiver authorization from a state or tribe that indicates this is a foster care placement).
Yes
No
Clear selection
Was this child adopted after foster care or kinship care?
Yes
No
Clear selection
Is your family experiencing inadequate housing or homelessness? (Doubling-up with friends or family, in emergency or transitional shelter or moving from place to place).
Yes
No
Clear selection
Has your child ever been expelled or removed from a child care or preschool program?
Yes
No
Clear selection
Is your child potty trained?
Yes
No
Other:
Clear selection
Does your child still nap?
Yes
No
Clear selection
Does your child have any medical conditions or allergies? If so, please explain below or mark N/A.
Your answer
Some Early Learning Programs are income based. Please enter the household size and income that best represents your family.
Your answer
Do you believe you would qualify for free/reduced breakfast or lunch?
Yes
No
Unsure
Clear selection
Would you claim that your child has no prior preschool experience and/or opportunities to play with other children?
Yes
No
Other:
Clear selection
Does your child show delays in social skills or learning skills?
Yes
No
Other:
Clear selection
How did you hear about the Early Learning Programs in Oak Harbor School District?
Your answer
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