Scholarship Application PLEASE NOTE: SCHOLARSHIPS ARE LIMITED AND MAY BE DISCONTINUED AT ANY TIME. Participation AgreementIf you do not agree to ALL of the following conditions, do not submit this form.For the CURRENT school year, please read the following conditions for participation and CHECK EACH BOX to indicate your agreement.* There is a $40 non-refundable registration fee for preschool in Granite School District. Students receiving scholarships must be part of a family that qualifies for free or reduced lunch, or the language spoken most often at home is NOT English. Students who enroll in this program are expected to remain in the program the entire school year. The school year begins August 2019 and continues through May 2020. Students who enroll in this program will be tested periodically to monitor academic progress. The preschool program is 3 hours per day, four days per week for 4-year-olds and two days per week for 3-year-olds. REGULAR ATTENDANCE IS EXPECTED! If your child has excessive absences, tardies or late pickups, 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. Parents are strongly encouraged to attend "Parent and Preschooler" activities, parent-teacher conferences two times per year, and participate in other parent activities if at all possible. Parents, grandparents, or other responsible adults should plan to help at least one day per month in your child's classroom. Parents are always welcome to visit or help in the classroom at any time. I enter into this agreement with Preschool Services pursuant to the guidelines outlined and understand that if I do not follow the agreement, my child may be dropped from the class at any time at the discretion of Preschool Services. By checking the boxes above, I acknowledge that I have read and accept the conditions of this agreement.For which school is your child registered?* Which langugage do you prefer for written notices?*EnglishSpanishChild's InformationLegal FIRST Name* Legal MIDDLE Name Legal LAST Name* Child's Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Primary Contact Information (Mother or Legal Guardian)Primary Contact's First Name* Last Name* Phone*Email* Enter Email Confirm Email Relationship to Student*Income InformationList EVERY person living in your household, related or not (grandparents, other relatives, friends, etc.). You must include yourself and all children living with you. You must list ANY and ALL income received from any individual in the household (worker's compensation, unemployment, social security, disability benefits, self-employment income, rental income, pensions, retirement, etc.). The amounts must be GROSS INCOME, meaning amount earned before taxes and any other deductions.List EVERYONE in household (use the "+" button to add more rows):NameAgeIncome from work before taxesOther incomeHow often? (yearly, monthly, weekly, etc.) (Use the "+" button to add more rows)Additional FactorsRead the list below. HOW MANY of these circumstances apply to your preschooler?*0123456789101112- 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 - Lives in a household with multiple families - Child exposed to physical abuse or domestic violence in the home - Child exposed to substance abuse (drugs or alcohol) in the home - 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 schoolAffirmationBy clicking "submit": I certify (promise) that all information on this application is true and accurate to the best of my knowledge. School officials have my permission to verify the information on this application. I may also be asked to provide full documentation of income, at any time. I understand that if I give false information or if I do not meet all of the terms of this agreement, my child(ren) will lose these tuition benefits.After clicking the 'Submit' button below, please wait until you see a confirmation page. Do not refresh. This iframe contains the logic required to handle Ajax powered Gravity Forms.