2017-2018 Madison City Schools First Class Pre-K Online Application
To participate in Madison City Schools First Class Pre-K classes, students must be four years old on or before September 1, 2017. If your child is selected to participate, you must provide proof of residency in Madison. You will be required to upload a copy of proof of residency to this application (lease or deed and other utility bill/power or gas).
Student's Full Name
*
First Name
Middle Name
Last Name
Student's Birthdate
*
-
Month
-
Day
Year
Date Picker Icon
Student's Gender
*
Male
Female
Do you have multiple siblings from your household applying for First Class Pre-K? If yes, please supply names.
Primary or Custodial Parent/Guardian's Full Name
*
Prefix
First Name
Middle Name
Last Name
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Cell, Mobile Phone, or Home Phone
*
Work Phone
Contact E-mail
*
Child physically resides with whom?
*
Mother and Father
Mother
Father
Grandparent
Other
Total number of persons living in the household
*
Primary language spoken in the home
*
English
Spanish
Other
What is the student's race/ethnicity?
*
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White or Caucasian
Prefer not to answer
Other
Highest level of education of someone in the household
*
Please Select
Below high school
High school graduate
Some college
College graduate
College post graduate degree
Family's total combined annual income
*
Does the family receive any public assistance?
*
Yes
No
Please select the type or types of assistance received
SSi
Disability
WIC
SNAP or Food Stamps
TANF
Medicaid
Other
Lease or Deed
*
Utility Bill
*
Submit
Should be Empty: