Welcome to Eaton County Preschool

Are you looking for FREE high quality early childhood program within Eaton County for a child who is 3-4 years old and wondering if you qualify?

The Interest form on this website is the first step in the process to apply for state and federally funded preschool options. After completing the form, you will still need to complete program enrollment forms and provide documentation to verify eligibility. Completing this preschool interest form does not guarantee a program placement.

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 on 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 1 will be enrolled if space is available.

If your child is less than 3 years of age, please complete the application below. We will contact you with some family resources in Eaton County which may include information about home visiting, playgroup opportunities or Early Head Start.

If you have questions please visit our “About Us” and “Frequently Asked Questions" page for additional information.

Preschool Application

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:

Program Preferences:

Preference 1:

Preference 2:

Preference 3:

Other Comments About Preferences

Parent/Guardian Information

Parent/Guardian 1:

First Name:

Last Name:

Parent/Guardian 2:

First Name:

Last Name:

Providing your email address will ensure regular communication about preschool.

Email Address:

Alternate Email:

Phone Number:

() -

Alternate Number:

() -

How would you prefer to be contacted?

Phone
Email
Text

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:

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

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

How did you learn about us?:

Child Care (Daycare) Information

Child Care (Daycare) Provider:

Name:

Child Care (Daycare) 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.