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State Funded Registration Request 2024-2025 (Wait List)
Please complete this Registration Request Form to put your child's name on the Wait List for State-Funded/Head Start preschool registration.
Eligibility is based on state and federal income guidelines. Provide us with ALL required information. You may also leave us comments at the end. You will receive an automated confirmation of your submission from Google Docs.
Based on the information you provide through this form, the PUSD Preschool Department will make an appointment for you submit documentation and determine your eligibility for state-funded preschool services.
Please allow for up to 10 business days after completing this form to receive your initial contact from the PUSD Preschool Department.
ALL INFORMATION IS KEPT CONFIDENTIAL.
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Email
*
Your email
Parent First Name
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Your answer
Parent Last Name
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Your answer
Phone
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Your answer
Address (including zip code)
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Your answer
Child's First Name
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Your answer
Child's Last Name
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Your answer
Child's birth date
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MM
/
DD
/
YYYY
Site - First Choice (choose only one)
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Any 3 hour class (State Class)
Any 6 hour class (Headstart/State class)
Morning Creek (3 hour (state)
Rolling Hills AM (3 hour state)
Valley (3 hour state)
Del Norte ( 3 hour State)
Los Penasquitos 6 hour (Headstart/state)
Pomerado 6 hour (Headstart/state)
Sundance 6 hour (Headstart/state)
Del Norte 6 hour (Headstart/state)
Site - Second Choice (choose any that you would be willing and able to attend)
Any 3 hour class (state)
Any 6 hour class (Headstart/state)
Morning Creek (3 hour State)
Rolling Hills AM (3 hour State)
Del Norte (3 hour state)
Valley (3 hour state)
Los Penasquitos 6 hour (Headstart/state)
Pomerado 6 hour (Headstart/state)
Sundance 6 hour (Headstart/state)
Del Norte 6 hour (Headstart/state)
Total MONTHLY Income BEFORE taxes from all sources (wages, spousal/child support, cash aid, housing allowance, self-employment income),
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Your answer
Family Size - How many are living in your household?
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Your answer
Do you or someone in your family receive TANF?
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Yes
No
Do you or someone in your family receive SSI?
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Yes
No
Do you or someone in your family receive SNAP?
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Yes
No
Do you or someone in your family receive Calfresh?
Yes
No
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