2008-2009 Clinton 4-Year-Old Preschool

Student Application 2008-2009 Clinton 4-Year-Old Preschool Clinton Community School District This program provides access and funding to a quality preschool program. Participation is based on funding availability. Charges for any additional services are not covered by this program. Please complete this application if you would like your child to be enrolled and to participate. You will be notified of your child’s participation and Preschool location when final placement decisions have been made.

Child’s Name ______Date of Birth ______

Parent’s Name ______Home Phone Number ______

Address ______Work Phone Number ______

City, State, Zip ______Cell Phone Number ______Must be 4-years-old on or before September 15, 2008 to qualify.

Preschool Site Choice: (please number in order of preference: 1, 2, and 3) ____Ashford ____Stay N’ Play ____AM ____PM ____AM ____PM

____Prince of Peace ____Wee School for Little People ____AM ____PM ____AM ____PM

____Zion Preschool ____YWCA Children’s Center ____AM ____PM ____AM ____PM

____St. John’s Lutheran ____No Preschool Preference ____PM only ____AM ____PM

Extended or Full-Day If income eligible, are you interested in being considered for full-day HEAD START preschool? Yes___ No____ Not Sure____

If not eligible for full-day HEAD START, do you need child care in addition to preschool? Yes____No____ Not Sure____

Transportation The Clinton Community School District reserves the right to make final preschool assignments based on distance child will need to be bussed and availability of bus routes. Parents always have the option of providing their own transportation to and from their preschool of choice. 1. Will your child need transportation from your home to the preschool site? Yes____ No____ Not Sure____

2. Will your child need transportation from your child-care provider to the preschool site? *Yes____ No____ Not Sure____ *If “Yes,” print name, address and phone number of your child-care provider below.

______Name of Child-Care Provider Address Phone

Return completed Student Application to any preschool listed or: Doug Owen, Jefferson Elementary School, 720 4th Avenue S., Clinton, IA 52732 NOTE: Students will be placed according to when the application is/was received. (Applications received first will be placed first.)

While it is our intent to place students in the preschool of choice, this application DOES NOT guarantee a spot at a preferred preschool.

Call 242-5546 ext. 2236 for additional information.