Eligibility List Form- State Preschool (CSPP)
Thank you for your interest in enrolling your child in HUSD Early Learning State Preschool Program. Upon completion of this form your child will be added to our Eligibility List using the information provided below.
Your family must qualify within the Family's monthly gross income guidelines set below.
Alameda County Pilot Family Income Schedule

Family size:         1 or 2        3       4       5       6               7           8 
     Monthly
 Gross income:    $7,209       $8,154    $9,441   $10,952   $12,462   $12,745    $13,029+

*************Please only add children between the ages of 2 and 5 for preschool.************
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Email *
Untitled Title
Child # 1  First Name : *
Child # 1 Last Name: *
Child # 1 date of birth: *
MM
/
DD
/
YYYY
Child #2 First Name :
Child #2 Last Name:
Child # 2 date of birth:
MM
/
DD
/
YYYY
Do any of these apply?
Family Size: *
Total household monthly gross income: *
Parent/Guardian Name (A): *
Home Address: *
City *
Telephone number: *
Alternate phone number:
Home language *
State Preschool site of Choice *
Required
A copy of your responses will be emailed to the address you provided.
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