6wks - 4 yrs old UCC Pre-Application 25-26

6wks. to 4 yrs. old Educational Programs Pre-Application Form

STUDENT MUST BE OF APPROPRIATE AGE FOR DESIGNATED GRADE LEVEL BY SEP. 1ST, 2024
Program Applying For*

EHS - Infants: 6weeks to 35 monthsK3 - 3 years old by Sep. 1K4 - 4 years old by Sep. 1
Child's Information
Child's Full Name

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Gender*

MaleFemale
Ethnicity

HispanicNon-Hispanic
Race*

AsianBlack/African-AmericanWhiteOther
Child's resides with*

Both parentsMotherFatherGuardianKinshipFoster CareOther
Parent/Guardian Information
In which language do you prefer to communicate?*

EnglishSpanishOther
Parent/Guardian's Full Name*
Adult who is completing this application
Date of Birth*

MonthDayYear
Adult who is completing this application (Month/Day/Year)
Address*

Address

Street Address Line 2

CityState / Province

Zip Code
Phone Number: Home/ Celular*
Please enter a valid phone number.
Alternate
Please enter a valid phone number.
Email address*
example@example.com
Best time to contact you*
Are you employed?*

YesNo
Are you in school/training?*

YesNo
Additional Information
What is your annual income?*
(Before taxes)
Family Size Unit*
(example: 2 children + 1 parents = 3)
Do you currently receive any public assistance?*

TANFSSIWICSNAP (Food Stamps)WS (Wisconsin Shares/ Child Care)No
Is your family experiencing homelessness?*

YesNo
Does your child have a diagnosed disability?*

YesNo
If yes, please specify:*
Are you concerned about your child's behavior, speech, emotional or academic development?*

YesNo
If yes, please specify:*
Do you have another child(en) currently, or are you applying to UCC schools?*

NoYes, enrolledYes, applying
If yes, please list name(s) and grade(s):*
Yes, enrolled or Yes, applying
Which school year are you interested in applying to?*

2024-20252025-2026
Centers

UCC Ricardo Diaz, Early Learning Academy at 2130 W. Becher St. Milwaukee, WI 53215. Serving: children between 6 weeks to 2 years old 11 months, and only K3 program.

UCC Guadalupe South at 239 W. Washington St., Milwaukee, WI 5320. Serving: children between 6 weeks to 3 years old 11 months.

UCC Burnham campus at 1648 S 37th St, Milwaukee, WI 53215. Serving: children between 6 weeks to 2 years old 11 months

UCC Bruce Guadalupe Community School at 1028 S. 9th St. Milwaukee, WI 53204. Serving K4 program.
For EHS - Infants, which UCC Center are you interested in?*

UCC Ricardo Diaz, Early Learning AcademyUCC Guadalupe SouthUCC Burnham campus
Which UCC Program are you interested in? (Check all applies)

UCC Head Start: Head Start and Early Head Start Program are free, federally funded programs designed to promote school readiness for children from lower-income families. We provided comprehensive services, including health, nutrition, and parent involvement.
Wisconsin Shares (Wisconsin Department of Children and Families): The Wisconsin Shares Child Care Subsidy Program supports families by funding a portion of the cost of child care while the parents are working or participating in an approved activity.
UCC Scholarship Tuition: K3/K4 is not funded entirely by the Wisconsin Department of Public Education. There are fees associated with those levels. Our enrollment specialist will share those details with you and payment options during your information meeting.
UCC Program*

UCC Early/Head StartWisconsin SharesUCC Scholarship Tuition
How did you know about our programs?*

I'm currently UCC familyI'm a UCC EmployeeWord of mouth (friend, family)Poster/flyer in the communityKnow someone who works hereReferred by agency (WIC, Child Support Services, Child, Care Subsidy, etc.)Website/Google searchWalked/drove by the centerOther
NOTE: Completing this application does not signify that your child will be automatically enrolled. I understand that if my child is accepted at the United Community Center Schools, all school rules will be followed, including attendance and dress code guidelines and parent engagement expectations.
Parent Guardian Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

6wks. to 4 yrs. old Educational Programs Pre-Application Form