GSRP Pre-Screen
This form is intended for the potential families for the Trenton GSRP 2020-2021 school year.

You are being asked to complete a Pre-Screen Form with the Trenton GSRP Preschool to determine your eligibility for the program.

As we are a need based program, there are several uncomfortable but necessary questions that we must ask, in order to assess need. We apologize for any discomfort you may feel.

If you aren't comfortable filling out a Google Form, you may send an email to hornbeckk@trentonschools.com and forrestb@trentonschools.com with the answers to the questions. If neither of these options works for you, please send an email and include your phone number, and we can arrange a time for us to call you to ask these questions over the phone.
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Email *
Parent Name *
Child's Name *
Phone Number *
Child's Date of Birth *
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/
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Address *
Household Income Amount *
Include all income sources from all adults responsible for the financial support of child for 2019.
Family Size *
How many people live in your household for 50% or more of the year?
Has your child been diagnosed with a disability or developmental delay? *
Has your child been expelled from a preschool or child care center? *
What is the Primary Home Language for your child? *
Have both parents earned a High School Diploma? *
Has your child been exposed to Abuse and/or Neglect? *
Includes abuse/neglect of child as well as domestic/spousal abuse of parent or sibling.
Has your child experienced the loss of a parent? *
Could include armed services deployment, incarceration, chronic illness (physical, mental, emotional), or frequent changes in custody, grandparents raising grandchildren, single parent, foster family or marital problems.
Was either parent under 20 when their first child was born? *
Does your child have stable housing? *
Does your child live in a high-risk neighborhood? *
Child experiences daily exposure to environmental pollutants (lead exposure, rodents, insect infestations), high crime, violence ,injury, drug abuse, or death rates; unsafe or crowded housing ,lack of utilities, or no space for children’s play.
Has your child been exposed to toxic substances? *
Prenatal or postnatal toxic exposure including Fetal Alcohol Syndrome, children born addicted, or environmentally-induced respiratory problems.
Is your child toilet trained? *
Do you have any medical or behavioral concerns about your child? *
A copy of your responses will be emailed to the address you provided.
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