ESD Peer Model Preschool Application
Thank you for your interest in our program.  Our Peer Model Preschool is offered at JJ Smith School.  School will begin in September and run until June; Monday-Thursday from 1:00 PM to 3:30 PM.  Transportation is provided by families and space is very limited.  This is a tuition-based program and the monthly charge for the 2324 school year was $225 a month (actual fee for 2425 will be determined at a later date).  
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Email *
Child's Name: *
Date of Birth:   *
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Gender: *
Parent/Guardian Name: *
Address: *
Primary Phone Number: *
Home Language: *
Please describe any previous preschool or group experience your child has had: *
Please describe any medical conditions or allergies (if none, please write none): *
Can your child follow simple adult directions independently?  *
Can your child sit and attend to a story or an activity for 10 minutes? *
Is your child toilet-trained? *
Will your child tell an adult if they need to use the bathroom? *
Does your child play with other children?  *
Please describe your child's strengths: *
Please check the words that are most descriptive of your child: *
Required
What are some of your child's favorite activities? *
What would you like your child to gain from this experience?  *
What else would you like us to know about your child? *
A copy of your responses will be emailed to the address you provided.
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