Clackamas ESD PEER Program Application Form 2025-2026

Thank you for your interest in our Clackamas ESD PEER Program!

Our PEER Program offers a half-day classroom experience, Monday through Thursday, for children who do not receive IFSP services to learn alongside students who experience disabilities.

Program cost: $50 per month
Schedule Options: Morning (AM) or afternoon (PM) sessions (no full-day option)
Locations for 2025–2026: North Clackamas and Oregon City areas

Important Information:

This form expresses interest and does not guarantee enrollment.
Families will be notified of enrollment status by May 2025. Recruitment will continue until all slots are filled.
If your child is accepted, a more detailed referral packet will be required.

To Apply:

Please complete all fields in this form. Space is limited. If you need assistance, contact us at eceparents@clackesd.org.

Enrollment requirements:

Age & Eligibility: Child is 3 years old by September 1, 2025, not eligible for kindergarten, and is not eligible to receive special education services from Clackamas ESD.
Residency & Transportation: Family resides in Clackamas County and will provide transportation to and from the site.
Development & Independence: Child has self-help skills (uses the bathroom and eats independently) and meets immunization requirements.
Family Commitment: Parent/guardian agrees to complete a free developmental screener.
Tuition: $50 per month.

Gracias por su interés en nuestro Programa PEER. Nuestro programa PEER brinda la oportunidad a los niños sin discapacidades de aprender junto a niños que experimentan discapacidades. Aprender juntos ayuda a todos los niños a crear un sentido de comunidad dentro del aula.

Para ser considerado como un PEER, el niño debe cumplir con los siguientes requisitos de inscripción:

El estudiante debe tener 3 años para el 1 de septiembre y no ser elegible para el jardín de infantes.
El estudiante debe cumplir con los requisitos de vacunación.
El estudiante tiene habilidades de independencia/ayuda personal, como usar el baño y alimentarse de forma independiente.
El estudiante no es elegible actualmente para los servicios de educación especial del programa EI/ECSE de Clackamas ESD y no recibe servicios de EI/ECSE.
El estudiante reside en el condado de Clackamas.
El padre/tutor se compromete a proporcionar transporte hacia y desde el sitio.

Hay un pequeño costo mensual de $50 por mes para que los pares asistan.

Please confirm you have read and understand the enrollment requirements.

Child Information

Child's First Name

Child's Last Name

Gender

Child's DOB

mm/dd/yyyy

Child's Primary Language

Household

Parent/Guardian Name(s)

If two parents/guardians are in the household please list both (First Last)

Mailing Address (Street Address, City, State, Zip)

Contact Information

Primary Contact Person for Application

First Last

Primary Contact Phone Number

000-000-0000

Phone

Primary Contact Email Address

Preferred Contact Method

Preferred Contact Time

Session Preference

Location

Please note: Your child will be enrolled in the location geographically closest to your home address, unless you indicate otherwise in the comments field below.

Jennings Lodge: 18521 SE River Rd, Milwaukie, OR 97267 (Oregon City School District)

Clackamas Early Learning Center: 13435 SE 97th Ave, Clackamas, OR 97015 (North Clackamas School District)

Additional Comments

(Optional)

Enrollment Requirements

Please review carefully and check the boxes to confirm each statement is true.

Yes, my child will be age 3 by Sept. 1, 2025 and is not eligible for kindergarten.

Yes, my child has self-help skills, including using the bathroom and eating independently.

No, my child is not currently eligible for special education services from the Clackamas ESD Early Intervention / Early Childhood Special Education program and does not receive EI/ECSE services.

Yes, my child resides in Clackamas County.

Yes, I understand the parent/guardian commits to providing transportation to and from the site.

Yes, I understand there is a $50 monthly tuition.

Yes, I understand this is a half-day program (Monday through Thursday), and there are no full-day options available.

Next Steps

Please note that once you submit this form, you will receive an email asking you to complete two ASQ questionnaires. We are not able to continue processing your child's application until you complete the ASQ questionnaires.

Note: if you do not receive an email regarding the questionnaires shortly, please check in your Junk/Spam folder as it is an automated message.

Please confirm you have read and understand the above statement regarding the questionnaires.

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