JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
State Funded Registration Request 2022-2023 (Wait List)
Please complete this Registration Request Form to put your child's name on the Wait List for State-Funded/Head Start preschool registration.
Eligibility is based on state and federal income guidelines. Provide us with ALL required information. You may also leave us comments at the end. You will receive an automated confirmation of your submission from Google Docs.
Based on the information you provide through this form, the PUSD Preschool Department will make an appointment for you submit documentation and determine your eligibility for state-funded preschool services. Appointments may be held in person, virtually via Zoom conference or via telephone.
Please allow for up to 10 business days after completing this form to receive your initial contact from the PUSD Preschool Department.
ALL INFORMATION IS KEPT CONFIDENTIAL.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Phone
*
Your answer
Address (including zip code)
*
Your answer
Child's First Name
*
Your answer
Child's Last Name
*
Your answer
Child's birth date (NOTE: Children must be either 3 or 4 years old on or before 2/2/2023).
*
MM
/
DD
/
YYYY
Site - First Choice (choose only one)
*
Any 3 hour class
Any 6 hour class
Del Norte 3 hour
Rolling Hills AM 3 hour
Los Penasquitos 6 hour
Pomerado 6 hour
Sundance 6 hour
Valley 6 hour
Site - Second Choice (choose any that you would be willing and able to attend)
Any 3 hour class
Any 6 hour class
Del Norte 3 hour
Rolling Hills AM 3 hour
Los Penasquitos 6 hour
Pomerado 6 hour
Sundance 6 hour
Valley 6 hour
Total MONTHLY Income BEFORE taxes from all sources (wages, spousal/child support, cash aid, housing allowance, self-employment income),
*
Your answer
Family Size - How many are living in your household?
*
Your answer
Do you or someone in your family receive TANF?
*
Yes
No
Do you or someone in your family receive SSI?
*
Yes
No
Do you or someone in your family receive SNAP?
*
Yes
No
Comments
Your answer
Send me a copy of my responses.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Poway Unified School District.
Report Abuse
Forms
