Pre K Qualifying Application Form

2019 - 2020 School Year

Formulario españolNOTE: Changing language will erase the current form.

This form must be completed by a parent, guardian, or other individual having lawful control over the child.

Parent/Guardian's Information
First Name:
Last Name:
Relationship to Child:
Parent
Parent
Guardian
Phone Number:
Email Address:
Child Information
First Name:
Middle Name:
Last Name:
Date of Birth:
Child's Address
City:
AUSTIN
AUSTIN
BUDA
DRIFTWOOD
KYLE
MANCHACA
MAXWELL
NEIDERWALD
SAN MARCOS
UHLAND
Street Name:
Street Number:
Apartment or Unit Number:
Eligibility Information

Pre-K is a qualifying program. Please answer the questions in the following sections to help us determine your child's eligibility.

Residency Information
Does the child live in any of the following situations? Check all that apply.
Owner-occupied home (own or lease home, apt., etc.)
Military housing
Long-term agreed-upon living arrangement with a family member or friend
Emergency shelter or transitional housing
Hotel or Motel
Campground
Non-traditional housing space including cars, public spaces, or substandard housing
Foster care placement for six (6) months or less
Shared housing with friend, family, or others due to hardship
Does the child live with the parent or legal guardian?
Yes
Yes
No
Has the child ever been placed in Texas Department of Family and Protective Services kinship care, volunteer care, or foster care?
No
No
Yes

Military Information

Is the child a dependent of a member of one of the following?
Not a military dependent
Active member of Armed or Reserved Forces of the United States or
Member who has been injured or killed while on active duty or
Member who is currently listed as Missing In Action
Texas National Guard
Star of Texas Award

The Star of Texas Award honors peace officers, firefighters, and emergency medical first responders who were seriously injured or killed in the line of duty.

Is the child a dependent of a "Star of Texas Award" nominee?
No
No
Yes
Language Proficiency
What language is spoken in your home most of the time?
English
English
Spanish
Other
What language does your child speak most of the time?
English
English
Spanish
Other
Income Information
Do you receive SNAP benefits?
No
No
Yes
Do you receive TANF benefits?
No
No
Yes
Do you receive Medicaid benefits?
No
No
Yes
Do you receive CHIP benefits?
No
No
Yes
Number of residents in household:
Number of incomes in household:
Acknowledgement

ALL OF THE INFORMATION SUBMITTED IS CORRECT

I understand that Texas Penal Code Section 37.10 states that it is an offense to (1) make a false entry, or false alteration of a government record, (2) present a document with knowledge of its falsity, or (3) impair the verity or legality of the record.

I further understand that the Texas Education Code, Section 25.001(h), states that it is an offense to knowingly provide false information on a form required for enrollment of a student.

Offenses may result in legal actions including, but not limited to, fines and/or liability for payment of tuition.

I understand that by checking the checkbox next to "Yes, I agree" below constitutes a legal signature confirming that I acknowledge and agree to the above statement.
Yes, I agree (required)
Electronic Signature (Please type your first and last name)