Pre-Kindergarten Application - School District of Lancaster

"*" indicates required fields

* All fields are required.

Household Information

Parent Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Cell Phone*

Home Phone*

Your Email

How many people live at this location?*

What is your household annual income?*

Which of the following describes your family?*

Were you referred to this program by a Behavioral Specialist?*

Yes

Were you referred to this program by a doctor or caseworker?*

Yes

What was the reason for the referral?

Is your family experiencing housing difficulties including staying with a friend or family member living in a shelter or transitional housing?*

Yes

Does anyone in your family have any health concerns? (Examples: nutrition, drugs/alcohol abuse, mental health issues, etc.)*

Yes

Is a language other than English spoken at your home?*

Yes

Which language?

Student Information

How many students do you need to apply?*

Student 1

Name*

First Middle Initial Last

Gender*

Birthday*

Primary Choice of School*

Secondary Choice of School*

Is this child a Seasonal Student/Migrant (non-immigrant) or Refugee?*

Yes

Is this child an English Language Learner?*

Yes

Does this child receive special education services from IU13 or an early intervention program?*

Yes

Please check all services that apply.*

Speech/Language

Physical

Behavioral

Is this child part of the Child Welfare System?*

Yes

Please check all that apply.*

Foster Care

Kinship Care

Children & Youth Services

Did both parents graduate from high school or receive a GED?*

Yes

Was the mother under 18 when this child was born?*

Yes

Are either of this child's parents incarcerated?*

Yes

Student 2

Name*

First Middle Initial Last

Gender*

Birthday*

Primary Choice of School*

Secondary Choice of School*

Is this child a Seasonal Student/Migrant (non-immigrant) or Refugee?*

Yes

Is this child an English Language Learner?*

Yes

Does this child receive special education services from IU13 or an early intervention program?*

Yes

Please check all services that apply.*

Speech/Language

Physical

Behavioral

Is this child part of the Child Welfare System?*

Yes

Please check all that apply.*

Foster Care

Kinship Care

Children & Youth Services

Did both parents graduate from high school or receive a GED?*

Yes

Was the mother under 18 when this child was born?*

Yes

Are either of this child's parents incarcerated?*

Yes

Student 3

Name*

First Middle Initial Last

Gender*

Birthday*

Primary Choice of School*

Secondary Choice of School*

Is this child a Seasonal Student/Migrant (non-immigrant) or Refugee?*

Yes

Is this child an English Language Learner?*

Yes

Does this child receive special education services from IU13 or an early intervention program?*

Yes

Please check all services that apply.*

Speech/Language

Physical

Behavioral

Is this child part of the Child Welfare System?*

Yes

Please check all that apply.*

Foster Care

Kinship Care

Children & Youth Services

Did both parents graduate from high school or receive a GED?*

Yes

Was the mother under 18 when this child was born?*

Yes

Are either of this child's parents incarcerated?*

Yes

Student 4

Name*

First Middle Initial Last

Gender*

Birthday*

Primary Choice of School*

Secondary Choice of School*

Is this child a Seasonal Student/Migrant (non-immigrant) or Refugee?*

Yes

Is this child an English Language Learner?*

Yes

Does this child receive special education services from IU13 or an early intervention program?*

Yes

Please check all services that apply.*

Speech/Language

Physical

Behavioral

Is this child part of the Child Welfare System?*

Yes

Please check all that apply.*

Foster Care

Kinship Care

Children & Youth Services

Did both parents graduate from high school or receive a GED?*

Yes

Was the mother under 18 when this child was born?*

Yes

Are either of this child's parents incarcerated?*

Yes

Student 5

Name*

First Middle Initial Last

Gender*

Birthday*

Primary Choice of School*

Secondary Choice of School*

Is this child a Seasonal Student/Migrant (non-immigrant) or Refugee?*

Yes

Is this child an English Language Learner?*

Yes

Does this child receive special education services from IU13 or an early intervention program?*

Yes

Please check all services that apply.*

Speech/Language

Physical

Behavioral

Is this child part of the Child Welfare System?*

Yes

Please check all that apply.*

Foster Care

Kinship Care

Children & Youth Services

Did both parents graduate from high school or receive a GED?*

Yes

Was the mother under 18 when this child was born?*

Yes

Are either of this child's parents incarcerated?*

Yes

Please note: This is a preliminary application and if your child is selected you will need to complete the enrollment process and provide: birth certificate, immunization records, current proof of address (lease, mortgage, or utility bill), and proof of income.

Kindergarten Registration is OPEN!

The School District of Lancaster Pre-Kindergarten Application

Quality pre-kindergarten matters

Household Information

Student Information