Sevier School District - PreSchool Application

Participation Agreement

Please read the following conditions for participation and CHECK EACH BOX to indicate your agreement.

If you do not agree to ALL of the following conditions, do not submit the application.

Participation Agreement(*)

At least one parent will attend parent-teacher conferences two times per year.

I will provide proof of ALL household income (Free/Reduced Lunch Application).

I understand that students who enroll in this program will be tested periodically throughout the school year to monitor academic progress.

I understand that the school year begins in September and continues through May.

I understand that the preschool program is four days per week and REGULAR ATTENDANCE IS EXPECTED. If my child has excessive absences or tardies, they will be dropped from the class and their space will be filled with a child from the waiting list. If my child is absent, I will notify the teacher and state the reason for the absence.

My child will be at least 4 years old on September 1

My child is not eligible for Kindergarten (5 years-old on or before Sept. 1)

Registration does not guarantee your child's participation. Sevier District's ability to offer this program is contingent upon receipt of grant funding. Grant funding notification is not expected until late June/early July. Applicants will be notified ASAP once Sevier District learns if funding has been awarded or denied.

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DISCLAIMER: Registration does not guarantee your child's participation. Sevier District's ability to offer this program is contingent upon receipt of grant funding. Grant funding notification is not expected until late June/early July. Applicants will be notified ASAP once Sevier District learns if funding has been awarded or denied.

Preferences

Which preschool will your child attend?(*)

Monroe Preschool

Richfield Preschool

Salina Preschool

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School time preference?(*)

Morning

Afternoon

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Which language do you prefer for written notices?(*)

English

Spanish

Other

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Will your child require Bus transportation(*)

No

Yes

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Do you have other children who attend Sevier School District(*)

No

Yes

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Child's Information

Legal First Name(*)

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Legal Middle Name

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Legal Last Name(*)

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Child's Birthday(*)

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Child Gender(*)

Male

Female

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Child's PRIMARY Race/Ethnicity(*)

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Is your child eligible for Kindergarten (5 years-old on or before September 1st, 2023)?(*)

No

Yes

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What is the first language the child learned to speak?(*)

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What is the language most often spoken in the home(*)

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What is the language most often spoken by the student?(*)

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Is your child an English Learner(*)

Yes

No

I don't know

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Primary Contact Information (legal guardian)

Primary Contact First Name(*)

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Primary Contact Last Name(*)

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Home Street Address(*)

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Home City(*)

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Home Zip Code(*)

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Mailing Street or PO #

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Mailing City

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Mailing Zip

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Primary Contact Relationship to Student(*)

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Contact Phone (*)

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Email Address(*)

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Secondary Contact Information

Secondary Contact First Name

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Secondary Contact Last Name

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Home Street Address

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Home City

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Home Zip Code

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Secondary Contact Relationship to Student

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Contact Phone

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Email Address

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Risk Factor Assessment

Read the list below and select the statement that applies

Child was born to mother who was 18 years old or younger
A member of child's household is incarcerated
Child lives in a neighborhood with high violence/crime
One or both parents have a low reading ability
Family has moved at least once in the last year
Child has ever been in foster care
Lives in a household with multiple families
Child exposed to physical abuse or domestic violence in the home
Child exposed to stressful life events (death, chronic illness or mental health issues of a parent or sibling)
Language spoken in the home most often is NOT English
A parent of the child did not graduate from high school

My child meets No factors in the list above

My child meets 1 or 2 factores in the list above

My child meets 3 to 5 factors in the list above

My child meets 6 to 8 factors in the list above

My child meets 9 or 10 factors in the list above

My child meets 11 or more of the factors listed above

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Income Information

You can verify your eligibility by clicking the current income guidelines for free and reduced lunch .

Income Guidelines

Income(*)

No

Yes

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Affirmation

I certify (promise) that all information on this application is true and accurate to the best of my knowledge. School officials have my permission to verify the information on this application. I understand that if I give false information or if I do not meet all of the terms of this agreement, my child(ren) will lose these tuition benefits.

Deadline for application submission is August 1

DISCLAIMER: Registration does not guarantee your child's participation. Sevier District's ability to offer this program is contingent upon receipt of grant funding. Grant funding notification is not expected until late June/early July. Applicants will be notified ASAP once Sevier District learns if funding has been awarded or denied.

Submission Date

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Please type your name as signature(*)

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PreSchool Application

Participation Agreement

Preferences

Child's Information

Primary Contact Information (legal guardian)

Secondary Contact Information

Risk Factor Assessment

Income Information

Affirmation

Inspire the mind, create a passion for learning, educate for success in life.