Preschool Online Application 2020-2021
***If your child is currently enrolled in PRESCHOOL you do NOT need to register.

Parents or Legal Guardians

You may start the process for PRESCHOOL by completing this online application.  You will still be required to provide the following documentation prior to your child being enrolled in the Preschool Program.  

Proof of income
Certified Birth Certificate
Original Social Security Card
Current KY Immunization Certificate
Current KY Eye Examination
Current KY Dental Exam
Current School Physical

Casey County public preschool education programs are available for:

-all four-year-old children whose family income is no more than 160% of poverty;

-all three and four-year-old children with developmental delays and disabilities, regardless of income;


The preschool program is designed to be developmentally appropriate for young children.  "Developmentally appropriate" is defined in law to mean that the program focuses on the child's physical, intellectual, social and emotional development, including interpersonal, interpersonal, and socialization skills.

If you suspect your child may be experiencing delays that could meet the criteria for a developmental delay or disability, please contact Barry Lee at 606-787-6941

-You will be contacted by a representative from our preschool program in late July or early August to set up a date to submit the following documents and for a screening date.  (You will not be contacted until COVID-19 restrictions are lifted)

If you have any questions, please contact me from the information below.

Thanks
Barry Lee
Director
606-787-6941
barry.lee2@casey.kyschools.us


Sign in to Google to save your progress. Learn more
PREREQUISITE INFORMATION
Student's Grade Level (2020-2021) *
This form is only intended for preschool students.
Do you receive benefits through SNAP and/or KTAP? *
SNAP = Supplemental Nutrition Assistance Program (AKA Food Stamps) | KTAP = Kentucky Transitional Assistance Program
IF you DO NOT receive SNAP or KTAP benefits, what is your annual household income?  If affected by the COVID-19 work restrictions, please supply us with any income information (unemployment, etc) *
How many people currently live in your household *
WHO SHOULD I INCLUDE AS MEMBERS OF MY HOUSEHOLD? You must include all people living in your household, related or not (such as grandparents, other relatives, or friends) who share income and expenses. You must include yourself and all children living with you.  If you live with other people who are economically independent (for example, people who you do not support, who do not share income with you or your children, and who pay a pro-rated share of expenses), do not include them.
STUDENT INFORMATION
Student's First Name *
Student's Nickname *
What name does your child go by, if not his/her legal first name?
Student's Middle Name
Student's Last Name *
Student's Birth Date *
MM
/
DD
/
YYYY
Student's Gender *
Student's Ethnicity *
Student's Race *
Student's PHYSICAL Address
Where does the student live?
Student's Physical Address - Street *
Student's Physical Address - City *
Student's Physical Address - State *
If other than KY, use state abbreviation, please.
Student's Physical Address - ZIP Code *
Student's MAILING Address
Where should mail, pertaining to this student, be sent?
Student's Mailing Address - Street/PO Box *
Student's Mailing Address - City *
Student's Mailing Address - State *
If different from "Physical Address (State)," use state abbreviation, please.
Student's Mailing Address - ZIP Code *
PHONE NUMBERS
Primary Phone Number *
How can we reach you if we have questions about registration?
Mother/Female Guardian Cell Phone Number
Optional, but helpful.
Father/Male Guardian Cell Phone Number
Optional, but helpful.
SCHOOL ATTENDANCE
Which preschool will your child attend during the upcoming school year? *
If a preschool classroom is maxed out, please understand that your child may be assigned to a preschool classroom outside your attendance zone.  
PARENT/GUARDIAN INFORMATION
Name of Mother/Female Guardian *
How is Mother/Female Guardian related to the student? *
Name of Father/Male Guardian *
How is Father/Male Guardian related to the student? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Casey County School District. Report Abuse
Google Forms