Application for USD 323 Preschool

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The child must be 4 years old by August 31, 2025. Online applications should be completed by a parent or guardian. Applications will be considered for in-district families and employees of USD 323 schools. Out of district requests will be considered upon determined availability. Completion of the application helps school staff determine the level of interest in preschool and qualifying information. You will be contacted by the school office regarding enrollment. Please call the Rock Creek District Office at 785-494-8597, if you have questions.

Child's First and Last Name *

As printed on birth certificate

Child's Date of Birth *

YYYY

Child's Gender *

Female

Male

Child's Race *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian / Other Pacific Islander

White

Multi-racial / Biracial

Hispanic or Latino? *

Yes

Child's Language *

What language is spoken in the home?

Child's Insurance Status *

No insurance coverage

KanCare (Medicaid/State Medical Insurance)

Private/Other

Military Insurance (Tri-care)

Child's Home Address *

Street Address, City, State, Zip Code, and County

Mailing Address (if different)

PO Box, City, State, and Zip Code

Child has an Individualized Education Plan (IEP) *

An IEP includes specialized services, recommendations, related services (i.e. speech, gross motor development, etc)

Yes

First and Last Name of Parent or Legal Guardian completing the application *

Parent or guardian date of birth *

YYYY

Relationship to child *

Father

Mother

Guardian

Foster parent

Parent/Guardian Race *

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian / Other Pacific Islander

White

Multi-racial / Biracial

Parent/Guardian: Hispanic or Latino? *

Yes

Parent/Guardian language(s) *

What language is spoken in the home?

Parent/Guardian primary phone number *

Parent/Guardian secondary phone number *

Parent/Guardian email address *

If you do not have an email address, please enter N/A.

Which school will your child attend? *

Children who live in homes located along Eliza Road and north will attend Westmoreland Elementary.

St. George Elementary

Westmoreland Elementary

Is a parent/guardian a USD 323 employee? *

Yes

Parent/Guardian education: *

What is the highest level of education of parent/guardian?

Currently enrolled in high school

Of high school age, not enrolled

Less than high school diploma

G.E.D.

High school diploma

Some college/training

Technical training certificate

Associate degree

Bachelor degree or higher

Other

Check all that apply to your family: *

The following statements determine if your child is eligible for reduced or free preschool services. Additional documentation may be required at the time of enrollment.

Income at or below 130% of federal poverty guidelines (family must qualify for free lunches)

Custodial parent is unmarried on the first day of school

At least one parent/guardian was a teen at the time of THIS child's birth

Preschool has been mandated for the child by the Department of Children & Families (DCF)

Child qualifies for migrant student status (agricultural, fishery, food processing work)

Child has limited English proficiency

Child is experiencing homelessness

Either parent is lacking a high school diploma or GED

I am concerned that my child may be developmentally delayed

None of the above

Required

In the past 12 months, has your family accessed any of the following? *

Supplemental Security Insurance (SSI)

Temporary Assistance to Needy Families (TANF)

Medicaid

Food Stamps

Special Supplemental Nutrition Program for Women, Infants, & Children (WIC)

Section 8 / public housing

Child care subsidy (DCF)

None of the above

Required

Which best describes the living arrangements of your family? *

Stable housing

Sharing the housing of others due to loss of housing, economic hardship, or a similar reason

In a shelter or transitional shelter

Unsheltered (campground, park, car, or other place not designated for permanent housing) or in substandard housing

Number of people living in the home where this child resides *

Income sources for family *

Wages (examples: pay stubs, W-2s, Tax Return Form 1040)

Child support and/or alimony

Worker's compensation

Unemployment

Agricultural

Pension/Retirement

Scholarship/Grant

Social Security

Supplemental Security Insurance (SSI)

Temporary Assistance to Needy Families (TANF)

Other

Required

Estimated total yearly family income *

Consider all income sources checked or listed above

Less than $10,000

$10,000-$19,999

$20,000-$29,999

$30,000-$39,999

$40,000-$49,999

$50,000-$59,999

Greater than $60,000

If my child does not qualify for a free/reduced-fee (state-funded slot), we are interested in a fee-based slot for $250 per month. *

Check with the school office for monthly costs.

Yes

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