UNIVERSITY PLACE SCHOOL DISTRICT Fax: 253-566-5607 ...

FORMS MUST BE RETURNED TO EDUCATIONAL SERVICE CENTER ONLY

UNIVERSITY PLACE SCHOOL DISTRICT

Educational Service Center 3717 Grandview Dr. West University Place, WA 98466-2138

Phone 253-566-5600 Fax: 253-566-5607

Integrated Community Preschool Application Form

2018-2019

What is the Integrated Preschool Program?

This is a tuition-based, half-day program (am or pm) offered 5 days per week for 4 year olds and 2 or 5 days per week for

3 year olds. Children in the Integrated Community Preschool Program have the opportunity to work and play with age

appropriate peers who have similar developmental levels as well as peers with developmental challenges.

If you are interested in the Integrated Community Preschool Program for your child, please complete this form and return to the Educational Service Center (ESC), at the address noted above. Do not return it to the school site.

Student Legal Name:

Male Female

Address:

Date of Birth Home Phone Number:

Parent/Guardian Name: E-Mail Address:

Work / Cell Number

If you reside within the UPSD boundaries, please indicate your resident/home school:

CHAMBERS

EVERGREEN

SUNSET

UNIVERSITY PLACE PRIMARY

Eligibility Criteria: 1) Child must be 4 by August 31st, 2018. Placement of 4 year old children will be given priority. 2) Children who are 3 by August 31st, 2018 will be placed based on seats available 3) Child must be toilet trained 4) Parent must be able to transport the child to and from the program. No busing services are available. 5) Address verification required with current utility bill

Please indicate if you have an AM or PM preference for you child. ____AM ____PM ____No Preference

Parents of 3 year olds please indicate preference for ___2 days per week or ___ 5 days per week

Monthly Tuition 5 days per week:

$ 270.00 Full Tuition $ 135.00 Reduced 1 Tuition** $ 67.50 Reduced 2 Tuition**

Monthly Tuition 2 days per week

$ 110.00 Full Tuition $ 55.00 Reduced 1 Tuition** $ 27.50 Reduced 2 Tuition**

To be considered for "Reduced 1" or "Reduced 2" tuition, please complete the "Fee Reduction" application at the ESC or on the district website at upsd.wednet.edu on the "Forms" tab.

** UPSD OFFERS A LIMITED NUMBER OF FEE REDUCTION SPACES **

We will begin accepting applications on March 27th, 2018. Notification of program placement will begin the last week of May. Please note: Completing this form does not guarantee placement in the Integrated Community Preschool Program.

Student placement will be based on program availability.

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I understand that if my student is accepted to attend the Integrated Preschool program in UPSD, tuition must be paid by the specified due date. Past due tuition may result in my child being removed from the program. A deposit equal to one month's tuition will be required once the student is accepted into the program.

Parent Signature _______________________________________

Date _______________________

Submitted to: ____________________________

Tuition Rate Full Reduced 1 Reduced 2

District Use Only

Accepted: yes no

Date:_____________________

Administrator Signature: _____________________________________

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