Saginaw Public Schools Preschool Interest Form
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Child's Name *
First
Middle Initial
*
Last
Date of Birth *
MM
/
DD
/
YYYY
Gender
Ethnicity
Address *
*
City
*
State
*
Zip
School District *
Select the school district in which you reside.
Program Location *
Preference 1
Preference 2
Preference 3
Comments about preferences
Parent/Guardian Information *
First Name
*
Last Name
E-mail Address
*
Phone Number
Alternate Number
Marital Status
Child Lives With
Number of Adults Living in Household *
Number of Children Living in Household *
Parent/Guardian 1 Gross Income *
Verification of income will be required.
*
Frequency of income
Parent/Guardian Income Source
Is this more than stated on Parent/Guardian's 2104 income tax return?
Clear selection
Have there been any income changes for any Parent/Guardian in the last 6-12 months?
Clear selection
Is there any additional information that you can share about your child/family?
Explain any concerns checked
Has your child ever been referred/involved in the following:
Current services received by family:
Childcare Information
Childcare Provider
Childcare Address
City
State
Zip
*
Required
Submit
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