Early Childhood Academy (Pre-K) Application

Early Childhood Academy (Pre-K) Application 2024-2025

Step 1 of 7

14%

Select "Yes" if you have been in contact with Stephanie Hurd, KQ's Family and Community Engagement Coordinator.(Required)

Yes

This application is for the Full Day Pre-K for 2, 3, and 4-year-olds only.

Will your child turn 4 years of age by August 15, 2024?(Required)

Will your child turn 3 years of age by August 15, 2024?(Required)

Will your child turn 2 years of age by August 15, 2024?(Required)

Uh Oh! Your child is not eligible for the Early Childhood Academy this year.

Would you like to notified when your child is eligible?(Required)

Child's Name(Required)

First Last

Child's DOB(Required)

MM slash DD slash YYYY

Parent's Contact Information(Required)

First Last

Phone(Required)

Email(Required)

1.) CHILD'S INFORMATION

Provide information about your child. Please check to ensure accuracy!

Student's Name(Required)

First MI Last Suffix (Jr., etc.)

Date of Birth:(Required)

Age:(Required)

Please enter a number from 1 to 7.

Gender:(Required)

Male

Female

Other

Prefer not to answer

Race(s) & Ethnicity:(Required)

Black or African American

White

Asian

Native American

Hispanic or Latino

Prefer not to answer

Are you enrolling a second child?(Required)

Yes

Student's #2's Name:(Required)

First MI Last Suffix (Jr., etc.)

Student's #2's Date of Birth:(Required)

Student's #2's Age:(Required)

Please enter a number from 4 to 19.

Student's #2's Gender:(Required)

Male

Female

Other

Prefer not to answer

Student's #2's Race(s) & Ethnicity:(Required)

Black or African American

White

Asian

Native American

Hispanic or Latino

Prefer not to answer

Are you enrolling a third child?(Required)

Yes

Student's #3's Name:(Required)

First MI Last Suffix (Jr., etc.)

Student's #3's Date of Birth:(Required)

Student's #3's Age:

Please enter a number from 4 to 19.

Student's #3's Race(s) & Ethnicity:(Required)

Black or African American

White

Asian

Native American

Hispanic or Latino

Prefer not to answer

Student's #3's Gender:(Required)

Male

Female

Other

Prefer not to answer

Home Address:(Required)

Street Address Apartment # City State ZIP Code

Length of Residence(Required)

Any Legal Alerts?(Required)

If yes, explain:

2.) Parent or Guardian Information

Provide information for the primary caregiver for this child.

Guardian Name:(Required)

First Last

Phone #:(Required)

Email:(Required)

Relationship:(Required)

Is this person completing the form?(Required)

Yes

If no, who is?

First Last

Guardian Address(Required)

Same as child

Street Address Apartment # City State ZIP Code

Contact Information

Authorized Pick Up?(Required)

Primary Contact?(Required)

Legal Guardian?(Required)

If no, who is the child's Legal Guardian?(Required)

First Last

Parent Guardian Additional Information

Please provide demographic information about the parent/guardian listed above.

Relationship Status:(Required)

Education Level:(Required)

Employment Status:(Required)

Full-Time

Part-Time

Unemployed

Not working

Employer Name:(Required)

Job Title or Position:(Required)

Work Phone:(Required)

Work Address (Optional)(Required)

Street Address Address Line 2 City State ZIP Code

Add Parent/ Guardian?(Required)

Parent/Guardian Information #2

Optional: contact information for a second parent or guardian.

Parent/Guardian Name:(Required)

First Last

Relationship:(Required)

Phone Number:(Required)

Email:(Required)

Does this person live with child?(Required)

Address(Required)

Same as child

Street Address Apartment # City State ZIP Code

Authorized Pick Up?(Required)

Education Level:(Required)

Employment Status:(Required)

Full-Time

Part-Time

Unemployed

Not working

3.) Household Information

Please provide accurate demographic information about the household. This information is for data purposes and will not be shared.

Type of Residence(Required)

Apartment

House

Other

Rehousing or Homelessness in past 18 months?(Required)

Yes

How many adults (anyone 18+) live in household with child?(Required)

Please enter a number from 1 to 15.

How many children (anyone under 18) live in household? Including this child.(Required)

Please enter a number from 1 to 15.

Members of Household(Required)

Mother

Father

Grandparent(s)

Step-parent(s)

Guardian(s)

Foster Parent(s)

Brother(s)

Sister(s)

Cousin(s)

Aunt(s)

Uncle(s)

Other

Select the family members who currently live with this child.

How many brothers live with child?(Required)