Income Verification | Pennoyer Preschool

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The Preschool for All Grant provides Pennoyer School with funding to offer free preschool to at-risk students in the community. We are thrilled to provide our students with meaningful and engaging learning opportunities, and feel fortunate to receive money from the State to provide our students meaningful and authentic learning experiences! In order for Pennoyer to receive funding and continue to offer free preschool, Pennoyer staff and families must work together to share required information with the State.

The State requires all preschool families report resources, use of agency support, and income verification. These pieces of information are imperative for Pennoyer to collect in order for your child to participate in the Pennoyer preschool program. The information that the State is requesting does not determine eligibility for the program. The information gathered is a requirement for all schools so that the State can analyze, and then determine growth of the preschool program. More information about the State’s requirement can be accessed on the Illinois State Board of Education Website or by viewing the following link: https://www.isbe.net/Documents/Income-Verification-FAQ.pdf

Thank you for your cooperation and please do not hesitate to reach out to Alicia Schmeisser, Director of Student Services, with additional questions! - aschmeisser@pennoyerschool.org

Email *

Child's full legal name *

Date of birth *

YYYY

Primary Caregiver's Name *

Relationship to Child *

Please select the statement that captures your child's previous experience with childcare. *

1 | Licensed family childcare (ex. a licensed in home daycare)

2 | Center based program (ex. Little Red Riding Hood, Kiddie Academy, Norridge Park District)

3 | My child did not attend any sort of childcare

Please select the home structure that best describes your situation. *

1 | Both parents in the home

2 | Single parent in the home

3 | Lives with an adult other than the guardian

4 | Youth in care

5 | Parents have joint custody

Please provide your family’s annual household income *

Please provide the number of persons in the Family/Household *

Please check any of the below resources that you are receiving or have access to at this time. *

Public Benefits

WIC

SNAP

CCAP

Medicaid Card

TANF

Not Applicable/None

Required

If the child is found eligible for the PFA program, I can provide the following to meet the Illinois grant requirement of proving income: *

Pay stubs (indicating consecutive income over the course of 30 days)

W2 form

Required

Please use this chart to determine your income percentage, taking into account the number of people in your household.

Using this above chart as a reference, please select the percentage that captures your household. *

50% or below

100% or below

200% or below

400% or below

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

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