MEEP PreK Application 2024-2025

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All applications need to be submitted by April 30, 2024, in order to be included in the placement lottery,

Email *

Full Name of Child *

Child's Date of Birth *

YYYY

Gender

Street Address ( Program is for Medford Residents Only):

Preferred Program (First Choice) *

Please select your first choice of Program (Dollar amounts indicate Monthly Tuition)

Preferred Program (Second Choice)

Please select your first choice of Program (Dollar amounts indicate Monthly Tuition)

Preferred Program (Third Choice)

Please select your first choice of Program (Dollar amounts indicate Monthly Tuition)

Preferred Program (Fourth Choice)

Please select your first choice of Program (Dollar amounts indicate Monthly Tuition)

Language(s) spoken by Child: *

Primary Language spoken in the home *

Has your child been evaluated, or is your child in the process of an evaluation for special education services? *

Has your child received services from Early Intervention? *

Does your child have an Individualized Education Program (IEP)

Name of Parent/Caregiver #1 *

Cell Phone *

Home Phone

Work Phone

Relationship to Child: *

Email Address:

Living in Same Household as Child *

Name of Parent/Caregiver #2

Cell Phone #2

Home Phone #2

Work Phone #2

Relationship to Child #2

Email Address #2

Living in Same Household as Child #2

A copy of your responses will be emailed to the address you provided.

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