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Preschool Interest List (2024-25)
Preschool Interest List (2024-25)
Parent Guardian
Please provide infrormation for the primary parent/guardian of the child you are applying for
Relationship to child
*
Answer Required
Please Select
Biological/Adopted/Step
Foster
Grandchild
Other
First Name
*
Answer Required
Last Name
*
Answer Required
Phone Number
*
Number Required
Email Address
*
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Address
Please provide the address of the primary parent/guardian
Is your family experiencing homelessness?
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Please Select
No
Yes
Street Address
*
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City
*
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State
*
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Please Select
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Texas
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Virginia
Washington
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Zip/Postal
*
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Household Size
*
Parent(s)/Guardian(s)
Answer Required
Additional Parent/Guardian
Please complete this section for the second parent/guardian who currently resides at the same address as the primary parent/guardian.
Is there another parent/guardian in the family?
*
Answer Required
Please Select
No
Yes
Contact Information
First Name
Answer Required
Last Name
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Phone Number
Number Required
Email Address
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Child (Applicant Information)
Please complete this section for the child you are applying for.
First Name
*
Answer Required
Last Name
*
Answer Required
Birthdate
*
Answer Required
Does the child have an active Individualized Learning Plan (IEP)?
Answer Required
Please Select
No
Yes
Family Information
Household Size
*
Answer Required
Gross Monthly Income
Amount earned prior to tax deductions
Answer Required
Is your family receiving services from WIC?
Answer Required
Please Select
Yes
No
Is your family receiving CalWorks/CalFresh?
Answer Required
Please Select
Yes
No
Confirmation Email
Confirmation Email
Email Required
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