Early Connection Program/State Preschool Pre-Registration Form

Dear Parents/Guardians,

Thank you for your interest in enrolling your child(ren) for preschool. Lake County Office of Education has several different preschools operating throughout the county. If you need help in deciding which program you want your child to attend, we will be happy to assist you. Families must meet income guidelines set by the State Department of Education to qualify for preschool. Enrollment is as follows; four year olds have priority, followed by three year olds and then if room is available we can accept five year olds who are not age eligible for Kindergarten.

Please fill out the pre-application and attach all necessary documentation listed below:

  • 1 Month's Current Income From All Sources
    (If income includes cash aid please submit notice of action or passport to services for confirmation and case number)
  • Birth Certificates of Child Enrolling and All Siblings in Family
  • Immunization Records
  • Proof of Current Address (Must submit 9 Digit Zip Code)
  • Physician's Report: If enrolling child has had a physical in the last year a Physician's Report must be submitted. If enrolling child has not had a physical within the last year an appointment must be scheduled and an APPOINTMENT CARD MUST BE SUBMITTED.

This is not the complete application to enroll your child in the preschool program. This is a pre-application to determine if your child qualifies for the program!

  • Families that have submitted the pre-application will be called to schedule an appointment to complete the enrollment.
  • Due to the lengthy enrollment process and limited space we ask that you do not bring children to your scheduled appointment.

If you are unable to find child care please call to reschedule your appointment

Please call the child development office with any questions or concerns at 263-4563, Yasmin Blancas Ext. 218

LCOE Operates Preschool Programs at the Following Elementary Schools:

Please select the preschool(s) that you are interested in enrolling your child in:


Enrolling Child/ren Name

Last

First

MI

Birthdate (month, day, year)


Other Children in the Household

Foster Child


Guardianship


Does your child have an Individualized Education Plan (IEP) or an Individualized Family Service Plan (IFSP) through any school or agency?


Have any of your children ever attended any of our LCOE Afterschool or State Preschool before?


How Many total are in household:

Adults Residing in Home Related by Blood, Marriage, or Adoption to Child/ren Above

Last Name

First Name

MI

Home Phone #

Work Phone #

Street Address

City

Zip Code



Mailing Address

City

Zip Code

Name

Email