Pre-k Enroll App online version
Kenai Peninsula Borough School District
Federal Programs
Sandy Miller, Assistant Director
148 North Binkley Street Soldotna, Alaska 99669-7553
Phone (907) 714-8892 Fax (907) 262-6354
Title I PRE-K Application
circle school of attendance area
SECTION 1 – CHILD INFORMATION
Child’s Name: _____________________________________________________________________
Last First Middle Nickname
Date of Birth: ____________________ Gender: _____ (Female / Male)
Mailing Address: ___________________________________________________________________
Physical Address: __________________________________________________________________
Is the student Hispanic or Latino? Yes_____ No ____
Caucasian __ AK. Native __ American Indian __ Asian __ Black ___ Pac. Islander ___
LANGUAGE OTHER THAN ENGLISH: ____________________________________________
SECTION 2 - FAMILY INFORMATION
Father: ___________________________________ ______________________________
Full Name Employer
Phone: _______________ / _______________ / _______________ / _______________
Home Work Cell Message
Email Addresses: _______________________ _______________________
Father Mother
Mother: ___________________________________ ______________________________
Full Name Employer
Phone: _______________ / _______________ / _______________ / _______________
Home Work Cell Message
Child primarily resides with _________________________________________________________________
Emergency Contact Person: ___________________________________ __________________
Name Contact Phone
___________________________________ __________________
Name Contact Phone
Has this child ever been enrolled in a Pre School Program?
Yes ____ No _____ Where? _______________________ Dates _____________________
Is this child, or his/her siblings eligible for services under (please mark all that apply)
Migrant Education ____________ ELL (English Language Learner) ________________
Special Education ____________ Free or Reduced Lunch _____________________
Homelessness _____________
Schools currently attended by siblings ________________________________________________________
REQUIREMENTS:
Regular attendance is expected. Students miss important concepts with just one absence. You will be contacted if your child has numerous unexcused absences. He/she will be placed on PROBATIONARY STATUS and could be removed from the program.
PARENT INVOLVEMENT:
Parents/guardians are strongly encouraged to volunteer in the Title I PRE-K program. Research has shown that parent involvement in the education process is vital for student success
I would be interested in volunteering in the following capacity: (Circle ALL that apply)
|Room Volunteer |Bulletin Board |Materials Preparation |
| |(can be completed at your home) |(can be completed at your home) |
|Snack/Recess Aide |Phone Tree Parent |Other: |
All information supplied will be held in strict confidence by the administration.
Student acceptance into this program will be based on results from an initial assessment. Screenings will take place in late April or early May. A fall screening may be available if there is still room in the program for additional students. Please contact your neighborhood school for screening dates and locations and to schedule an appointment.
Parent/Guardian Signature ___________________________________ Date ____________
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Anchor Point, Chapman 235 8671 Homer, Paul Banks 226-1801 Kenai – Mountain View 283-8600
Kasilof, Tustumena 260-1345 Nikiski, Nikiski North Star 776-2600 Soldotna, Redoubt 260 4300
Soldotna, Soldotna El 260-5100 Seward – Seward El 224-3356 Sterling, Sterling, Elementary 262-4944
This is an APPLICATION only. If accepted, your child will need to be screened and registered. Please contact your neighborhood school for screening dates and locations and to schedule an appointment.
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