Welcome to Van Buren Free Preschools

Are you looking for a free or very low-cost preschool opportunity for your child? This application is the first step to see if they qualify for the Great Start Readiness Program (GSRP). We have classrooms located throughout the Van Buren ISD service area, providing high quality preschool during the school year.

We work cooperatively with area Head Start programs, whose preschool services are available to both 3 and 4 year-olds. This ensures all eligible children receive services.

The “About Us” tab above gives you a link to find out more details on the process.

Preschool Interest Form

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 this more than stated on Parent/Guardian 1's 2021 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.

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 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 currently have health care coverage?

Yes No

Would you like someone to follow-up with you to discuss health care coverage?

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.