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Welcome to Clinton County Preschool

Are you interested in free preschool for a child who is 3 to 5 years old? Many children qualify! If you think your child might qualify, complete the form below or call (855) 644-PreK and someone will be in touch with you about the free preschool opportunities that are available to residents of Clinton County.

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 December 1st to be eligible for GSRP, if your child is 5 years old by September 1st they are not eligible for these programs.

Children who turn age 4 on or before September 1st will be prioritized for enrollment. Children who turn age 4 September 2 through December 1st will be enrolled if space is available.

Visit About Us to learn what makes a child eligible for free preschool.

Preschool Interest Form

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

School Year:

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:

Street Address 2:

City:

Zip Code:

Parent/Guardian Information

Parent/Guardian 1:

First Name:

Last Name:

Parent/Guardian 2:

First Name:

Last Name:

Email Address:

Providing your email address will ensure regular communication about preschool.

Phone Number:

() -

Alternate Number:

() -

How would you prefer to be contacted?

Phone
Email

Marital Status:

Child Lives With:

(check all that apply)

Number of people 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

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 this more than stated on Parent/Guardian 1's 2019 income tax return?

Yes No

Have there been any income changes for either Parent/Guardian in the last 6-12 months?

(i.e., unemployment, wage increase/decrease, etc.)

Yes No

Additional Information

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

Rollover highlighted text for definitions.

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

Has your child been referred/involved in:

(check all that apply)

Early Childhood Special Education
Early Head Start
Early On
Head Start

Current services received by family:

(check all that apply)

DHHS Child Care Assistance
DHHS Financial
DHHS Food Assistance
Medicaid

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?:

Childcare Information

Childcare Provider:

Name:

Childcare Address:

Street Address:

Street Address 2:

City:

State:

Zip Code:

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

It is the policy of the Clinton County Regional Educational Service Agency (RESA) that no discriminatory practices based on gender, race, religion, color, age, national origin, disability, height, weight, marital status, sexual orientation, political affiliations and beliefs, or any other status covered by federal, state or local law be allowed in providing instructional opportunities, programs, services, job placement assistance, employment or in policies governing student conduct and attendance. Any person suspecting a discriminatory practice should contact the Associate Superintendent for Special Education, 1013 South US-27, St. Johns, MI 48879, or call 989-224-6831.

This site was developed by Clinton County RESA Office of Innovative Projects with funds from a grant awarded by the Michigan Department of Education.