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.

Clare-Gladwin RESD


Preschool Interest Form

Child's Name:

Date of Birth:
Gender: Male
Female
Ethnicity:
(check all that apply)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Hispanic of any race
Unknown
Address:

County:
Program Preferences:

Where would you like services provided?
Rollover text for definitions.
Parent/Guardian Information
Parent/Guardian 1:

Parent/Guardian 2:

Providing your email address will ensure regular communication about preschool.

Phone Number:

() -

Alternate Number:

() -

How would you prefer to be contacted?
 Phone
 Email
 Text
Marital Status:
Single
Married
Divorced
Widow
Separated
Child Lives With (Primary Physical Custody):
(check all that apply)
Mother
Father
Both Parents
Joint Custody-Physical
Joint Custody Legal
Foster Care
Legal Guardian
Grandparent
Other:
Number of immediate family members living in the household:

Parent/Guardian 1 Income Information
Parent/Guardian 1 Gross Income:
Income before taxes or other deductions. Verification of income will be required.

Choose the period the above wage represents:

Any Additional Income:
(ex. Child support, rental income, etc)

Choose the period the above wage represents:

Parent/Guardian 1 Income Source:
(check all that apply)
Working
Child Support
Supplemental Security Income (SSI)
Temporary Assistance for Needy Families (Family Independence Program)
Other:
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
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)
DHHS Child Care Assistance
DHHS Financial
DHHS Food Assistance
Medicaid
Women, Infants and Children (WIC)
I am pregnant and/or have a child birth to 3 and would like information on birth to 3 program options.

Yes   No

How did you learn about us?:
 Advertisement
 Community Organization
 Event
 Friend/Family Member
 Teacher/Education Professional
 Website
 Other:
Child Care (Daycare) Information
Child Care (Daycare) Provider:

Child Care (Daycare) Address:

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