Application for Early Kindergarten Entrance

Please complete this form if your child has a birth date that occurs between August 1 and October 15 * and your child demonstrates academic achievement, social, emotional, and physical maturity appropriate for kindergarten placement * and should be considered for early placement in kindergarten. Parents/legal guardian of any assessment age child must furnish (a) a certified copy of the student’s birth certificate issued by the state in which the child was born, or (b) other reliable proof of the child’s identity and age, (passport, Visa, or Permanent Resident Card). This is required to complete this form.

Information about your student

Student Legal Last Name*

Student Legal First Name*

Student Preferred First Name

Student's Date of Birth*

Your child must turn 5 years old between August 1st and October 15th to be considered for Early Kindergarten Entrance.

Student Ethnicity*

Select

Student Race*

Select

Certified Copy of Birth Certificate*

Parents/legal guardian of any assessment age child must furnish (a) a certified copy of the student’s birth certificate issued by the state in which the child was born, or (b) other reliable proof of the child’s identity and age, (Passport, Visa, or Permanent Resident Card). A picture of any of these forms is acceptable to attach.

Drag and drop files here or

Primary Language Spoken by the Student*

Home Address*

City*

State*

Zip*

Home Phone*

Home Phone Unlisted

Parent Email Address*

Who is your student living with?

Adult (1) in Household:*

Relationship (1) to Student*

Gender (1) of Adult in Household*

Female

Male

Adult (2) in Household:

Relationship (2) to Student

Gender (2) of Adult in Household

Female

Male

Primary language spoken by the family

Interpreter Needed

Has your child received special education services?*

Yes

Description of Services

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