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USD 309 Pre-K 3 & Pre-K 4 Application Form
Please complete the the form below if you are interested applying for a USD 309 early childhood program. Completing this application does not mean you are accepted into the program. You will be notified if you child has been accepted.
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* Indicates required question
What preschool program are you applying to be part of?
*
Nickerson Elementary Pre-K 3 (Half-Day 8:10-11:40)
Nickerson Elementary Pre-K 4 (Full-Day 8:10-3:25)
South Hutchinson Pre-K 3 (Half-Day 8:10-11:40)
South Hutchinson Pre-K 4 (Full-Day 8:10-3:25)
Will your child be potty trained by August 1, 2024? This is a requirement to attend the program.
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Yes
No
Child's Name
*
Your answer
Child's gender
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Male
Female
Child's birthdate
*
MM
/
DD
/
YYYY
Parent/Guardian address (Including street, town, and zip code)
*
Your answer
Parent/Guardian Cell Phone Number
*
Your answer
Parent/Guardian Alternative Phone Number
*
Your answer
What school district do you live in?
*
Nickerson-South Hutchinson USD 309
Hutchinson USD 308
Fairfield USD 310
Buhler USD 313
Haven USD 312
Pretty Prairie 311
Will you need bus transportation? (Must live in USD 309 district)
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Yes
No
Are you interested in after school daycare?
$80/week- 3-year olds 11:30-5:30
$40/week- 4-year-olds 3:25-5:30
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Yes
No
What is the marital status of the parents?
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Single
Married
Separated
Divorced
Was your child referred to our Pre-K program?
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Yes
No
Referring agency or individual:
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Doctor
Parents as Teachers
DCF
Early Ed Center
Other
None
Required
If "Other" was chosen, please enter name of referring agency or individual.
Your answer
Parent/Guardian email address(es)
*
Your answer
Name of parent #1 (first and last name)
*
Your answer
Birthdate of parent #1
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MM
/
DD
/
YYYY
Highest level of education of parent #1
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Some high school
High School Graduate
GED
Some college
College graduate
Name of Parent #2 (first and last name)
Your answer
Birthdate of parent #2
MM
/
DD
/
YYYY
Highest level of education of parent #2
Some high school
High School Graduate
GED
Some college
College graduate
Clear selection
Is a language other than English spoken in the home?
*
Yes
No
If "Yes", please type the language(s), other than English, spoken in your home.
Your answer
Does the child have an IEP?
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Yes
No
Does your family/child have migrant status? (
Has your family moved in the last 36 months to seek or obtain agriculture or fishing related work?)
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Yes
No
List any special health or learning needs of your child, including allergies.
Your answer
Free Lunches Screener:
Choose the option that best represents your family income.
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Family size of 2 with an income up to $22,646
Family size of 3 with an income up to $28,548
Family size of 4 with an income up to $34,450
Family size of 5 with an income up to $40,352
Family size of 6 with an income up to $46,254
Family size of 7 with an income up to $52,156
Family size of 8 with an income up to $58,058
Our family income is not represented above
Check all that apply
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My family is currently receiving help from a federal, state, or local government program such as TANF, WIC, Food Stamps.
The child's parent gave birth to them while they were 19 years of age or younger
This is a single parent home.
The child is currently under state care, living in a foster home, or in a kinship situation.
The parent has behavior concerns
The child is receiving treatment for mental health concerns.
The child has a chronic illness that impacts his/her daily routine.
At least one of the child's parents or guardians is currently serving in the military.
None of the above applies to our family, or child.
Other:
Required
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