Special Education Registration

Welcome to Granite School District’s Preschool program!

Your child has qualified to receive no-cost Special Education services. To ensure we have accurate and complete records, please complete the registration form below.

All students attending our preschools are required to pay a $45 non-refundable registration fee each year. This payment can be made today in our office or by phone at 385-646-4672.

According to published guidelines from the Utah State Board of Education (USBE), preschools are exempt from standard fee waivers. However, we offer families of students who qualify for special education services the opportunity to apply for a fee waiver for their special education student only.

If you believe you may qualify, please complete a Registration Fee Waiver Application and include the required verification information. After review, a decision will be emailed to you. Until a decision has been made, the registration fee will not be charged.

Special Education Registration Form – new students ONLY

"*" indicates required fields

Funding Source

Our preschool’s financial support comes from multiple sources. To determine the source of your child’s funding, please answer the following questions.

Does your family qualify for free or reduced lunch?*

Yes – Free Lunch

Yes – Reduced Lunch

No, not free or reduced lunch

I don’t know

How many people live in your household?

more than 8

Is the gross (before tax) household income less than $3,261 per month?

yes

Is the gross (before tax) household income less than $4,109 per month?

yes

Is the gross (before tax) household income less than $4,956 per month?

yes

Is the gross (before tax) household income less than $5,804 per month?

yes

Is the gross (before tax) household income less than $6,652 per month?

yes

Is the gross (before tax) household income less than $7,500 per month?

yes

Is the gross (before tax) household income less than $8,348 per month?

yes

READ THE LIST BELOW AND COUNT HOW MANY OF THESE CIRCUMSTANCES APPLY TO YOUR PRESCHOOLER:

– Child born to mother who was 18 years old or younger
– A member of child’s household is incarcerated
– Child lives in a neighborhood with high violence/crime
– One or both parents have a low reading ability
– Family has moved at least once in the last year
– Child has ever been in foster care
– Currently lives in a household with multiple families
– Child exposed to physical abuse or domestic violence in the home at any point in time
– Child exposed to substance abuse (drugs or alcohol) in the home at any point in time
– Child exposed to stressful life events (death, chronic illness or mental health issues of a parent or sibling)
– Language spoken in the home most often is NOT English
– A parent of the child did not graduate from high school

How many of those circumstances apply to your preschooler?*

Is the child currently in Foster Care?*

yes

Is your child an English Learner? (see definition below)*

yes

The child: was not born in the United States, or whose native language is NOT English, or – is a Native American or Alaska Native, or a native resident of the outlying areas and comes from an environment where a language other than English has had a significant impact on their level of English language proficiency, or – is migratory, whose native language is NOT English and who comes from an environment where a language other than English is dominant AND has difficulties in speaking, reading, writing, or understanding the English language that may be sufficient to deny the child the ability to meet challenging state academic standards or successfully achieve in English-instructed classrooms, or the opportunity to participate fully in society.

Affirmation: By checking the box below, I certify that the prior information I have provided is true and accurate to the best of my knowledge.*

I am a parent of the child and I agree with the above statement.

Child's Information

Legal FIRST Name (Primer Nombre)*

Legal MIDDLE Name

Legal LAST Name (Apellido)*

Child's Gender*

Female

Male

Child's Birthdate*

Month

Day

Year

Child's Age on September 1, 2025:

2 years old

3 years old

4 years old

If your child is 5+ years old on this date, they must register for kindergarten. Please contact your local school.

Child's PRIMARY Race / Ethnicity*

Asian

Black

Caucasian

Hispanic / Latino

Pacific Islander

Native American / Alaskan Native

What language does the child speak most often? (If they do not yet speak, what language is most often spoken at home?)*

What language did the child learn first? (If they do not yet speak, what language is most often spoken at home?)*

What is the primary language used in the home, regardless of the language spoken by the student?*

Does the student have the opportunity to hear/speak another language? If so, which language?

What is the preferred language for written notices?*

English

Spanish

With whom does the child live?*

Both Mother and Father

Mother

Father

Other

Primary Contact Information (Parent or Legal Guardian)

Primary Contact's First Name*

Primary Contact's Last Name*

Primary Contact's Street Address*

Primary Contact's City*

Primary Contact's Zip Code*

Primary Contact's Relationship to Student*

Primary Contact's Cell Phone Number*

Primary Contact's Home Phone Number

Primary Contact's Work Phone Number

Primary Contact's Email Address*

Enter Email Confirm Email

THIS IS IMPORTANT! Most preschool communication will be sent via parent portal and/or email. To assist you in creating a parent portal account, we must have an accurate email address.

Secondary Contact Information (Parent or Legal Guardian)

Secondary Contact's First Name

Secondary Contact's Last Name

Secondary Contact's Street Address

Secondary Contact's City

Secondary Contact's Zip Code

Secondary Contact's Relationship to Student

Secondary Contact's Cell Phone Number

Secondary Contact's Home Phone Number

Secondary Contact's Work Phone Number

Secondary Contact's Email

Emergency Information

Please provide up to three emergency contacts other than those listed above.

Emergency Contact's Full Name*

Emergency Contact's Relationship to Student*

Emergency Contact's Phone Number*

Is this emergency contact also permitted to pick up the student?

yes

Full Name – Emergency Contact 2

Relationship to Student

Phone

Is this emergency contact also permitted to pick up the student?

yes

Full Name – Emergency Contact 3

Relationship to Student

Phone

Is this emergency contact also permitted to pick up the student?

yes

Restrictions

If you have a LEGAL DOCUMENT restricting someone from contact with your child, please list that person here and provide a copy of the document via email to preschool@graniteschools.org. If there is no legal document, do not list anyone here. Please include the person's name, relationship to the student, and phone number if available. Use a separate line for each person.

Health Information

Physician and/or Specialist Details

Name

Phone #

Does your child have any of the following?

Allergies (Foods, Medications, etc.)*

Yes

Allergy Details*

Does child have an Epi Pen / Antishistmane?*

Yes

Epi Pen / Antihistamine Details*

Asthma*

Yes

Asthma Details*

Is a "rescue" inhaler needed in the class?*

Yes

Inhaler Details*

G-tube*

Yes

G-tube Details*

Chronic condition / medical diagnosis*

Yes

Condition / Diagonisis Details*

Diabetes*

Yes

Diabetes Details*

Heart or circulatory disorder*

Yes

Heart Details*

Musculoskeletal disorder*

Yes

Musculoskeletal Details*

Seizures*

Yes

Seizures Details (list type & daily medications)*

Visual Impairment*

Yes

Visual Details*

Registration Fee Required

A $45, non-refundable registration fee is required. Please pay the fee with a debit or credit card before you leave today.

Participation Agreement

Please read the following conditions for participation and CHECK EACH BOX to indicate your agreement.

I agree that:*

Student’s data may be shared with an independent evaluator for Research & Evaluation purposes, subject to federal law.

Parents must attend parent-teacher conferences two times per year.

Students who enroll in this program will be tested periodically througout the school year to monitor academic progress.

The school year begins August/September and continues through May.

The preschool program is four days per week for 4 year olds, or 2 days per week for 3 year olds, and REGULAR ATTENDANCE IS EXPECTED. If your child has excessive absences or tardies, they will be dropped from the class and their space will be filled with a child from the waiting list. If your child is absent, you must notify the teacher and state the reason for the absence.

Parent participation is an important part of a child’s educational success. Therefore, parents are strongly encouraged to attend parent education opportunities to enhance their child’s development of literacy and math skills at home.

All information contained in this application is true and accurate to the best of my knowledge.

How did you hear about our program?

Flyer

Internet

Returning Student

Referred by Someone

Elementary School Sign/Web Page/Newsletter

Other

After clicking the ‘Submit’ button below, please wait until you see a confirmation page. Do not refresh.