Survey - Inquiry Pre-K Counts Market St

Inquiry Pre-K Counts Market St

Pre-K Counts is a free program for qualifying families. Please take time to answer these questions so we can determine eligibility.

Question - Required - Parent/Guardian Name

Question - Required - Child's Name

Question - Required - Child's Birth Date

Month

Day

Year

Question - Required - Home Address

Question - Required - City/State/ZIP

Question - Required - Phone Number

Question - Required - Is your family at or below the 300% poverty level? Must answer YES to qualify. (Persons in Household: 1-$38,280, 2-$51,720, 3-$65,160, 4-$78,600, 5-$92,040, 6-$105,480, 7-$118,920, 8-$132,360, Add $4,480 for each person over 8)

Question - Required - Email:

Question - Required - Has your child been referred to Pre-K Counts by a health/mental health practitioner?

Question - Required - Is the child in foster care, kinship care, or receiving Children and Youth Services? (You must be able to provide documentation.)

Question - Required - Guardian has NOT obtained a high school diploma or a GED?

Question - Required - Is English NOT the child's first language?

Question - Required - Is the child homeless?

Question - Required - Is one of the child's parents in prison?

Question - Required - Does the child have an active Individualized Education Plan (IEP)? (You must be able to provide the IEP.)

Question - Required - Is the child a migrant/seasonal student?

Question - Required - Was the child's mother under the age of 18 when the child was born?

Question - Required - Does the child have a sibling enrolled in a YWCA program? If so, which program?

Question - Required - Is your child currently enrolled in a YWCA program? If so, which program?

Question - Required - The Pre-K Counts school hours are 9AM until 2PM. Wrap Around is available at an additional cost. (Providing care for your child before and after the school hours) Would you like more information about the Wrap Around Program?

Question - Not Required - How did you hear about our program?