Welcome to Clare-Gladwin County Quality Preschool Partnership

Are you looking for free high quality preschool within Clare and Gladwin Counties for a child who is 3 to 5 years old and wondering if you qualify? Fill out our interest form below or call 989-386-8075 to determine if your child is eligible to attend a FREE Great Start Readiness (GSRP) or Head Start Preschool Program. For more information on available local programs and eligibility criteria, click on the About Us link on the left hand side of the screen. Any family wishing to apply for GSRP or Head Start in Clare and Gladwin Counties MUST COMPLETE this interest form.

Preschool Interest Form

School Year:

Please select the school year you are submitting this preschool interest form for:

2022-2023: Current school year, ending in June 2023.
2023-2024 : Next school year, beginning in September 2023.

Child's Information

Child's Name:

First Name:

Middle Name:

Last Name:

Date of Birth:

Gender: Male
Female

Ethnicity:

(check all that apply)

Address:

Street Address:

Apt./Lot Number:

City:

Zip Code:

County:

Program Preferences:

Preference 1:

Preference 2:

Preference 3:

Other Comments About Preferences

Click here for more information about preference choices.

Where would you like services provided?

Rollover text for definitions.

In a school or childcare centerClassrooms located in schools or childcare centers across the county. Early Head Start, Head Start, and GSRP programs provide developmentally appropriate learning in a safe, positive, nurturing environment; promoting social, emotional, physical, and cognitive growth with creativity and language development. Teaching teams use research based curriculum to promote school readiness to support each child with language, literacy, and math skills. Children make their own discoveries, using a balance of child-initiated and teacher-directed approaches.
In my own homeMany children and parents receive Early Head Start and Head Start services right in their own home! Home visitors come once a week and work with parents and their children. Together, the home visitor and parents watch and think about the child. They plan ways to help the child learn using parent-child interactions, daily routines, and household materials. A small group of children, parents, and their home visitors also gets together on a monthly basis for group socializations.

Parent/Guardian Information

Parent/Guardian 1:

First Name:

Last Name:

Providing your email address will ensure regular communication about preschool.

Email Address:

Phone Number:

() -

How would you prefer to be contacted?

Phone
Email
Text

Parent/Guardian 2:

First Name:

Last Name:

Email Address:

Phone Number:

() -

Address if different than child's:

Street Address:

City:

State:

Zip Code:

Marital Status:

Child Lives With (Primary Physical Custody):

(check all that apply)

Number of immediate family members living in the household:

Number of Adults:

Number of Children:

Parent/Guardian 1 Income Information

Parent/Guardian 1 Gross Income:

Income before taxes or other deductions. Verification of income will be required.

Wages: $

Choose the period the above wage represents: Weekly Bi-Weekly Monthly Annually Prior Year Income Tax Return

Any Additional Income:

(ex. Child support, rental income, etc)

Wages: $

Choose the period the above wage represents: Weekly Bi-Weekly Monthly Annually Prior Year Income Tax Return

Parent/Guardian 1 Income Source:

(check all that apply)

Working
Child Support
Supplemental Security Income (SSI)

Temporary Assistance for Needy Families (Family Independence Program)
Supplemental Nutrition Assistance Program (SNAP)/Food Assistance Program (FAP)
Other:

Are you paying child support to Parent/Guardian 2?

Yes No

Is Parent/Guardian 1 enrolled in school and/or a job training program?

Yes No

Additional Information

Is there additional information that you can share about your child/family?

Rollover highlighted text for definitions.

Has your child been referred/involved in:

(check all that apply)

Early Childhood Special Education
Early Head Start
Early On
Head Start

If your child is currently receiving Early On or special education services, please select from the following:

Individualized Family Service Plan (IFSP): Early On
Individualized Education Program (IEP): Special Education
No

Explain any concerns checked:

(i.e., evaluations, specialist, parent concern, lead count, primary language)

Is your child's current address a temporary living arrangement?

Yes No

Do you have reliable transportation?:

(for planning purposes only)

Yes No

Current services received by family:

(check all that apply)

I am pregnant and/or have a child birth to 3 and would like information on birth to 3 program options.

Yes No

Is there anyone else that you would like to authorize the district or program to discuss enrollment with?

Yes No

How did you learn about us?:

I understand and agree to having my information shared with local Head Start, Great Start Readiness Program, and Home Visiting Program providers.