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SCSD ECC New Student Application 2020-21
New Student Application for the 2019 - 2020 School Year.
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* Indicates required question
Student's Last Name
*
Your answer
Student's First Name
*
Your answer
Gender
Male
Female
Clear selection
Check All that Apply
*
Asian
Black / African-American
American Indian / Alaska Native
Hispanic / Latino
Pacific Islander/ Native Hawaiian
White
Required
Date of Birth
*
MM
/
DD
/
YYYY
State and Country of Student's Birth
*
Your answer
If Student was not born in the US, when did the student move to the US?
Your answer
Student's Primary Street Address
*
Your answer
Student's City and Zip Code
*
Your answer
Our Address is in the St. Charles School District Boundaries (Please note: priority is given to district residents.)
Yes
No
Clear selection
Mother's Name
Your answer
Mother's Street Address
Your answer
Mother's City, State, Zip Code
Your answer
Mother's Home Phone
Your answer
Mother's Cell Phone
Your answer
Mother's Email Address
Your answer
Father's Name
Your answer
Father's Street Address
Your answer
Father's City, State, Zip Code
Your answer
Father's Home Phone
Your answer
Father's Cell Phone
Your answer
Father's Email Address
Your answer
Student Primarily lives with:
*
Mother
Father
Both Parents in the same house
Parents who live in different houses and have shared custody of child
Who has primary custody of the student?
*
Both Parents
Mother
Father
Other (Grandmother, Foster, etc)
If 'other' than parent has custody of the student, who has guardianship?
Your answer
Guardian First Name
Your answer
Guardian Last Name
Your answer
Guardian Phone
Your answer
Has your child had a Special Education Evaluation?
*
Yes
No
Was your child in a Special Education Program?
*
Yes
No
Are you enrolled in the Parents as Teachers Program?
*
Yes
No
If Yes, who was the Parent Educator?
Your answer
Has your child had a DIAL-4 screening within the last 6 months?
*
Yes
No
If yes, date of screening.
Your answer
First Class Choice
*
Choose
2 Day - Full Day 8:00 a.m. - 3:00 p.m. ($300 Monthly Tuition August - May)
3 Day - Full Day 8:00 a.m. - 3:00 p.m. ($410 Monthly Tuition August - May)
5 Day - Half Day AM 8:15 a.m. - 11 30 a.m. ($340 Monthly Tuition August - May)
5 Day - Half Day PM 12:15 p.m. - 3:30 p.m. ($340 Monthly Tuition August - May)
5 Day - Full Day 8:00 a.m. - 3:00 p.m. ($635 Monthly Tuition August - May)
Second Class Choice
*
Choose
2 Day - Full Day 8:00 a.m. - 3:00 p.m. ($300 Monthly Tuition August - May)
3 Day - Half Day AM 8:15 a.m. - 11:30 a.m.($225.00 Monthly Tuition August - May)
5 Day - Half Day AM 8:15 a.m. - 11 30 a.m. ($340 Monthly Tuition August - May)
5 Day - Half Day PM 12:15 p.m. - 3:30 p.m. ($340 Monthly Tuition August - May)
5 Day - Full Day 8:00 a.m. - 3:00 p.m. ($635.00 Monthly Tuition August - May)
Before/After Care Needs (Choose One)
*
Choose
I will need Before Care ($95 Monthly)
I will need After Care ($140 Monthly)
I will need Before & After Care ($210 Monthly)
I do not need Before or After Care
Do you have any other children under the age of 5? If so, please list their Name(s) and Date of Birth and preschool attended/attending (if applicable).
Your answer
Are you a current St. Charles School District Employee?
Yes
No
Clear selection
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