Educational Service Center FORMS MUST BE RETURNED TO EDUCATIONAL SERVICE CENTER ONLY 3717 Grandview Dr. West University Place, WA 98466-2138 Phone 253-566-5600 UNIVERSITY PLACE SCHOOL DISTRICT Fax: 253-566-5607 Integrated Community Preschool Application Form 2019-2020 What is the Integrated Preschool Program? This is a tuition-based, half-day program offered 5 days per week for 4 year olds and 2 or 4 days per week for 3 year olds. Children in the Integrated Community Preschool Program have the opportunity to work and play with age appropriate peers who have similar developmental levels as well as peers with developmental challenges.

If you are interested in the Integrated Community Preschool Program for your child, please complete this form and return to the Educational Service Center (ESC), at the address noted above. Do not return it to the school site. Student Legal Name: □ Male □ Female Address: Date of Birth Home Phone Number: Parent/Guardian Name: Work / Cell Number E-Mail Address: The preschool program is held at Sunset Primary School. If you reside within the UPSD boundaries, please indicate your resident/home school: □ CHAMBERS □ EVERGREEN □ SUNSET □ UNIVERSITY PLACE PRIMARY

Eligibility Criteria: 1) Child must be 4 by August 31st, 2019. Placement of 4 year old children will be given priority of 4 and 5 day sessions. 2) Children who are 3 by August 31st, 2019 will be placed based on seats available 3) Child must be toilet trained 4) Parent must be able to transport the child to and from the program. No busing services are available. 5) Address verification required with current utility bill

2 day and 4 day programs are 8:00 a.m. -10:30 a.m. and are for 3 year olds and 4 year olds 5 day program is from 11:45 a.m. to 2:15 p.m. and is for 4 year olds

Parents of 3 year olds please indicate preference for ___2 days per week ___ 4 days per week ___ either is fine

Monthly Tuition 5 days per week: Monthly Tuition 4 days per week Monthly Tuition 2 days per week $ 270.00 Full Tuition $ 220.00 Full Tuition $ 110.00 Full Tuition $ 135.00 Reduced 1 Tuition** $ 110.00 Reduced 1 Tuition** $ 55.00 Reduced 1 Tuition** $ 67.50 Reduced 2 Tuition** $ 55.00 Reduced 2 Tuition** $ 27.50 Reduced 2 Tuition**

**To be considered for a full or partial Tuition Scholarship, please complete the “Fee Reduction” application attached.

We will begin accepting applications on March 26th, 2019. Notification of program placement will begin the last week of May. Please note: Completing this form does not guarantee placement in the Integrated Community Preschool Program. Student placement will be based on program availability.

------I understand that if my student is accepted to attend the Integrated Preschool program in UPSD, tuition must be paid by the specified due date. Past due tuition may result in my child being removed from the program. A deposit equal to one month’s tuition will be required once the student is accepted into the program and will be applied toward the first month’s tuition.

Parent Signature ______Date ______

District Use Only Submitted to: ______Accepted: yes no Date:______

Tuition Rate  Full  Reduced 1  Reduced 2 Administrator Signature: ______

University Place School District APPLICATION FOR “FEE ADJUSTMENT” for Preschool

Per board policy, the district offers fee reduction to students who are eligible for free or reduced meals under federal guidelines. To apply for reduced fees, please complete and sign this application and return it to your child’s school. This form must be completed annually.

Student Name:

Fee Description: Fee Amount:_

 Household Size:

The total of all persons, including parents, children, grandparents and all people related or unrelated who live in your home and share living expenses.

 Gross Monthly Income:

The total combined income all household members received last month before taxes. This includes wages, social security, pension, unemployment, welfare, child support, alimony, and any other cash income.

I understand I may be asked to verify the income stated and I certify under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct:

Parent/Guardian Signature:

Date:

District Use Only: Notification to Parent: (Date) Qualified Reduced Rate 1 – Amount Reduced Rate 2 – Amount

Does Not Qualify Approved by _Date