2024-2025 School Readiness Application

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Through a School Readiness grant funded by the Connecticut Office of Early Childhood, there are a number of spaces available in high-quality preschool programs at a reduced cost.

For the 2024-2025 school year, the Colchester School Readiness Program is actively seeking:
· Children who are not enrolled in a preschool program;
· Children who live in Colchester;
· Families who want a 5 day a week program;
· Families who may find it difficult to pay for preschool

Email *

Your Child's Street Address. Colchester residency will be verified before placement. *

Child's First Name *

Child's Middle Name

Child's Last Name *

Child's Date of Birth *

YYYY

Name of Parent to Contact *

Phone Number of Parent to Contact *

What option(s) below are you interested in (5 days per week required)? Check ALL that apply. *

CASTLE - School Day

Colchester Early Childhood Program - Part Day

Colchester Early Childhood Program - School Day

Required

Primary Language in Home *

English is primary language

Some English is spoken

No English is spoken

Gross Total Income of your Household from 2023 tax return. Income will be verified before the placement of a child into a program. Include Wages, SSI, Social Security, Rental Income, Worker’s Compensation, Unemployment, Foster Care Subsidy, Alimony, Pensions, Veterans Benefits, Cash Assistance, Dividends/Interest (if over $10/month). Please answer in $. *

Is your current income about the same as your tax return? *

Yes

No, my income is higher.

No, my income is lower.

Number of Parent(s)/Parent's spouse in household *

Number of Minor Children in Household *

About your Child *

Yes

Receives Birth to Three or Other Special Education Services

Has attended a program before

Is a foster child

What stressors apply to your family?

Disabled or chronically ill parent

Sibling with a significant diagnosed disability

Incarcerated parent

Deployed military parent

Domestic violence concern

Mental health concerns

Substance abuse

Current DCF involvment

Homeless or insecure housing situation

Grandparent/Relative as Guardian

Multiple Children 3- 5 years old

Parent deceased

Parent does not have high school diploma or GED

Any additional comments or concerns about your child or your family situation:

I attest that the information given is true and accurate to the best of my knowledge. Type your name in the box as your electronic signature. *

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

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Colchester Public Schools. Report Abuse

Forms