Pre K Application and Registration Information
2014 – 2015 Pre-Kindergarten Pre-Qualification
Application Information
The Pre-K program is a half-day program for which a student must pre-qualify to attend. (Specific hours for each session will be announced in May 2014)
Transportation is not provided.
Pre-K is located at: Rountree Elementary, 800 East Main Street, Allen, TX 75002.
TO PRE-QUALIFY:
The child must be 4 years old on or before September 1, 2014 and meet one or more of the following criteria:
❖ The child is Limited English Proficient (LEP), or
❖ Meets the Free and Reduced Lunch income eligibility guidelines, or
❖ The child meets the criteria of homeless, or
❖ The child is a military active duty dependent, or
❖ The child is or has been in the Foster Care Program.
Requirements:
❖ Applications will be available February 3, 2014, at the Early Childhood and Language Support Center, online and at all elementary school campuses.
❖ If you have any questions, please call the Early Childhood & Language Support Center
at 972-727-0506.
❖ Parents/Guardians need to return the completed applications with all required documentation in person to the Early Childhood and Language Support Center located at 610 E. Bethany, Suite 606A, Allen, Texas, 75002.
❖ Only complete applications will be accepted. Do not return applications to campuses.
❖ After a student’s eligibility is determined, a letter will be sent to parents notifying them if their child satisfies pre-qualification requirements for Pre-K.
❖ Students that require language testing will be contacted by the Early Childhood & Language Support Center to schedule an appointment for the student's language screening.
❖ Students who meet eligibility will receive an additional registration packet to finalize the registration at Rountree. Spaces are allotted on a first come, first served basis in a way that will keep classrooms balanced.
Completed Pre-K applications must be returned
in person with all required documents to the
Early Childhood & Language Support Center:
610 E. Bethany Road, Suite 606-A
Allen, Texas 75002
(972) 727-0506
Allen Independent School District
2014-2015 Pre-Kindergarten
Pre-Qualification Checklist
Please bring the following documents with you to the Early Childhood and Language Support Center in order to begin the pre-qualification process:
□ Child’s Birth Certificate or Hospital Birth Record
Records must indicate the child’s name, parents’ names, and date of birth. All children must be four years old on or before September 1, 2014 to apply for Pre-K.
□ Two Proofs of Residency
A current utility bill may be used as one proof of residency; the other must be a voter registration card, an apartment lease agreement, or the closing date on a home purchase. (Closing date must fall within the first six weeks of school to be eligible for enrollment.)
□ Pre-K Pre-Qualification Application
□ Spring 2014 Income Summary Form
□ Pre-K Pre-Qualification Agreement
□ Home Language Survey
Pre-K applications must be submitted in person to the Early Childhood and Language Support Center, located at 610 E.Bethany, Suite 606A, Allen, TX 75002. Incomplete applications will not be accepted. Please contact the Early Childhood and Language Support Center at (972) 727-0506 for more information.
Allen ISD 2014-2015 Pre-Kindergarten
Pre-Qualification Application
Child’s Name: __________________________________________________________ Gender: □Female □ Male
Date of Birth: _______________________________ Country where child was born: ___________________
(Birth date must be on or before 9-1-10)
Has the child ever been in the conservatorship of the Department of Family and Yes_____ No_____
Protective Services or the Foster Care Program?
Does the child have a parent serving active duty in the military? Yes_____ No_____
Was the child’s parent killed or injured during active military duty? Yes_____ No_____
Has a school, ECI, or another agency determined that the child has a disability? Yes_____ No_____
Do you believe the child has some type of disability?
(Example: difficulty communicating; problems hearing, walking or learning; slow development of skills) Yes_____ No_____
If yes, please describe: _______________________________________________________________________________________
Has the child ever received speech therapy services? Yes_____ No_____
Is the child currently attending PPCD or being evaluated in Allen ISD or another district? Yes_____ No_____
Only applications with all required information will be accepted.
Parent/Guardian: _______________________________________________ Home Phone: ___________________
Address: ______________________________________________________ Cell Phone: _____________________
City: ________________________________ Zip Code: _______________ Work Phone: ____________________
Parent Signature: _________________________________________ Session Preference: _____ Morning Pre-K*
(Indicates all information is correct) _____ Afternoon Pre-K*
*Specific hours for each session will be announced in May 2014.
Allen ISD does not discriminate on the basis of age, national origin, race, color, sex, religion, disability or against any other legally protected group.
Office Use Only
ESL:_______ Income: _______ Homeless: _______ Foster: _______ Military: _______ DS:_______ Bilingual:_______
Qual: ________AM __________ PM DNQ: __________ Initials: _______________ Date: ______________
Allen Independent School District
Pre-K Spring 2014 Income Summary
This form must be completed by all applicants, including those who may qualify for Pre-K on the basis of other criteria, such as language, a parent in the military or foster child status.
1) Pre-K Child’s Name:_______________________________________________________________________
2) Is this a FOSTER CHILD? Yes No
If this is a foster child, write the child’s monthly personal use income here, if any: $_________________.
Do not complete section #3 or #4. Go to section #5.
3) Are you getting FOOD STAMPS or TANF benefits for this child? YES NO
Food stamp case number:_________________________ TANF case number:___________________
Do not complete section #4. Go to section #5.
4) HOUSEHOLD MEMBERS: (Complete this section only if you did not complete sections #2 or #3).
List ALL household members, related or not, (such as grandparents, other relatives, or friends). You must include yourself and all children. Attach another sheet of paper if needed. List the types of income your household received and how often.
Employment Income: list the GROSS INCOME (before taxes and deductions).
Other Income: list the total amount each person received last month from all other sources (welfare, child support, alimony, pensions, retirement, Social Security, Worker’s Comp, unemployment, strike benefits, Supplemental Security Income (SSI), Veteran’s benefits (VA), disability benefits, regular contributions from people who do not live in your household, and ANY OTHER INCOME. If no income, check the box.
|Names: (list everyone in |Last month’s income and how often it was received: |Check box if no |
|Household) |Example: $200/weekly (W) or $150/monthly (M) or $100/every other week (2W) or $200/twice per month |income |
|Example: John Smith |(2M) | |
| |Earnings from work before|Welfare, child support, |Pensions, retirement, Social |All Other: | |
| |deductions: |alimony: |Security: | | |
|Example: James Smith |$ / |$ / |$ / |$ / | |
|2. |$ / |$ / |$ / |$ / | |
|3. |$ / |$ / |$ / |$ / | |
|4. |$ / |$ / |$ / |$ / | |
|5. |$ / |$ / |$ / |$ / | |
|6. |$ / |$ / |$ / |$ / | |
|7. |$ / |$ / |$ / |$ / | |
|8. |$ / |$ / |$ / |$ / | |
|9. |$ / |$ / |$ / |$ / | |
|10. |$ / |$ / |$ / |$ / | |
| | | | | | |
5) An adult household member must sign the form and list his or her Social Security Number or mark the box if he or she doesn’t have one.
I certify (promise) that all information on this application is true and that all income is reported. I understand that the school will get Federal funds based on this information. I understand that school officials may verify (check) the information. I understand that if I purposely give false information, my children will no longer be eligible for Pre-K, and I may be prosecuted. I understand that I will be required to submit an additional income verification form in August and provide supporting income documentation in order for my child to attend.
Sign here: ____________________________________________________ Date:____________________________________
Social Security Number: _________-________-__________ I do not have a Social Security Number
The Allen Independent School District will not discriminate in its educational programs, activities, or employment practices, based on race, color, national origin, or sexual orientation, disability, age, religion, ancestry, union membership, or any other legally protected classification. Announcement of this policy is in accordance with state and federal laws, including Title IX of the Education Amendments of 1972, Sections 503 and 504 of the Rehabilitation Acts of 1973, and the American Disabilities Act of 1990. Those who have an inquiry or complaint of harassment or discrimination, or who need information about accommodations for persons with disabilities, should contact: Kent Turner at (972) 727-1130.
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All parents who wish to apply for the Allen ISD Pre-K program must complete the Pre-K Spring 2014 Income Summary, even if your child may qualify for Pre-K on the basis of other criteria, such as language, military, or foster status. Applications without income information are considered incomplete and will not be accepted.
In compliance with AISD financial reporting and accountability guidelines, applications will be randomly selected for an internal audit. If selected as part of this audit, parents will be asked to submit income verification documents, such as a pay stub, unemployment documentation, letter from employer, or TANF/Food Stamps approval letter. If parents are unable to produce documents to support income indicated on the Income Summary form, the applicant will not be eligible to attend Pre-K.
Families who pre-qualify based on income will receive a second Income Verification form in July 2014 to verify that the family’s income level still falls within the qualifying range. The second form must be completed and returned to the Early Childhood and Language Support Center, within two weeks of receipt.
Please keep in mind that students who are pre-qualified by income for the Pre-K program are not guaranteed participation in program. Families who do not return the second income verification by August 15, 2014 or who no longer meet current income eligibility requirements will not be eligible to attend the Pre-K program, even if they originally pre-qualified for the program.
If a family’s income does not fall within the income guidelines, they will not receive a second Income Verification form in August and will not be required to submit further income verification.
Incomplete applications or income verification forms will not be processed. It is the parents’ responsibility to notify the Early Childhood and Language Support Center at (972) 727-0506 with any changes in address.
Parents may request morning or afternoon class placement, however, applications will be processed, on a first come, first serve basis.
________________________________________________________________________________
Please sign below to indicate that you have read and understand the procedures for application and admission into the AISD Pre-Kindergarten Program.
Student’s Name: ______________________________________________________________
Signature of Parent/Guardian: ______________________________Date: _________________
Allen ISD Home Language Survey
Home Campus: _______________________________________________________________
Student’s Name: ________________________________________ Grade: _____________
1. What language is spoken in your home most of the time? ________________________
2. What language does your child speak most of the time? _________________________
3. When did your child first enter U.S. schools? Date: ____ /____ /______ Grade: ______
month day year
4. Has your child ever attended a public school in Texas? ( No ( Yes
If yes, indicate the name of the school(s): ________________________________________
5. Has your child ever participated in an English as a Second Language (ESL) or Bilingual
program? ( No ( Yes
If yes, what type of program? ( ESL ( Bilingual District: _________________________
Parent/Guardian Signature: ___________________________________ Date: ___________
For PEIMS Data Specialist/Office Use:
Date received: _____________
If the Home Language Survey indicates that a language other than English is spoken or if the student was previously served in a Bilingual or ESL program, please fax or scan this form to the Early Childhood and Language Support Center and provide a copy to the ESL teacher on your campus.
FAX Number (972) 727-0531
Date faxed: _______________ Initials: ________________
Date copy of HLS given to ESL teacher: _________________
For Early Childhood and Language Support Center Use:
Date received: __________________________
Date(s) records requested: ________________
Date of testing: _________________________
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Jupiter Road
Bethany Dr.
Boyd
Elementary
School
AISD
Administration
Building
US 75
Central Expressway
Dillard Special Achievement Center
AISD Early Childhood & Language Support Center
|Hours of Operation |
| |
|8:00 a.m. - 4:30 p.m. Monday-Thursday |
|8:00 a.m. – 4:00 p.m. Friday |
Allen ISD 2014-2015 Pre-Kindergarten
Pre-Qualification Agreement
Revised 1/30/2014
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