2023-2024 Marysville Schools Preschool Peer Model Program Intake Form
 The Marysville School District provides early childhood education for young children with disabilities. To help provide a well rounded experience, Marysville Schools welcomes peer models within the classrooms. Peer models are typically developing children ages 3 ½ years old -5 years old displaying strong skills in socialization/leadership, communication/language skills and are toilet trained. Peer models should also be able to independently listen and follow teacher direction and interact with peers using cooperative play strategies within the classroom environment. Please complete the below form if you are a Marysville Schools resident and would like your child to be considered for Marysville Schools Preschool Peer Model Program for the 2023-2024 School Year.  Tuition cost is $150 monthly. 

Note: Age Requirement: Children age 3 by February 1, 2023 to start the first day of the 23-24 school year. 
Sign in to Google to save your progress. Learn more
Email *
Child's Last Name *
Child's First Name *
Child's Nickname
Date of Birth  *
MM
/
DD
/
YYYY
Parent(s)/Guardian(s) Name *
Are one of the parents an employee of MEVSD? *
Address *
Parent/Guardian Phone Number  *
Parent/Guardian Phone Number
Parent Guardian Email Address *
Parent Guardian Email Address
Class Preference *
List other preschool or group experiences 
How does your child separate from parents? *
Is your child the sibling of a current enrollee in our program? *
If yes, who is the student?
Please list your child's allergies if any: *
Please describe your child's strengths *
Please describe your child's weaknesses *
Can your child attend to an preferred/self-directed activity for at least 8-10 minutes?  *
Can your child attend to an adult directed activity for at least 4-5 minutes?
Clear selection
How does your child respond to directions given from and adult? *
How do you predict your child will react in the classroom (i.e. shy, outgoing, quiet)? *
How does your child interact with other children his/her age? *
Why would you like your child to be enrolled as a peer model? *
Does your Child Eat/Drink Independently? *
Does your child dress themselves (except shoes)? *
Is your child independently with toileting needs (may need help with difficult snaps)? *
Does your child verbally interact with peers in a play situation? *
Is your child's speech clear and understandable by unfamiliar adults?  *
Does your child respond to simple questions? *
Can your child follow simple directions? *
Can your child speak in clear English sentences? *
Does your child demonstrate an ability to use crayons, scissors and glue to complete a project? 
Clear selection
Is there any other information that you would like to share with us about your child? *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Marysville Exempted Village School District. Report Abuse
Google Forms