Welcome to Lenawee County Preschools

Are you looking for free high quality preschool within Lenawee County for a child who is 3 to 5 years old and wondering if you qualify? Please fill out our interest form below or call 517-264-5324 to determine if your child is eligible to attend a FREE Great Start Readiness Program (GSRP) or FREE Head Start preschool program in Lenawee County. For more information on available local programs and eligibility criteria, click on About Us. Any family wishing to apply for GSRP or Head Start in Lenawee County must complete this interest form.

Please be aware that according to new state guidelines, all children must be 3 years old on or before September 1st to be eligible for Head Start. Children must be 4 years old on or before September 1st to be eligible for GSRP.

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:

Program Preferences:

Preference 1:

Preference 2:

Preference 3:

Other Comments About Preferences

Click here for more information about preference choices.

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

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

Would you like someone to follow up with you to discuss our Successful Kids=Involved Parents (SKIP) Program SKIP to a Great Start services include:

Monthly, interactive home visits with a Parent Educator
Parent-child playgroups focusing on healthy development
Developmental screenings
Parenting information
Connections to community resources for families
Newsletters with tips on nutrition, activities for families and children, and the playgroup calendar

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.