Thank you for your interest in our GSRP Preschool Program!

To begin the enrollment process, please complete and submit the form below.

Fields marked with an * are required

CHILD INFORMATION

Please note: your child MUST be 4 by September 1, 2017 in order to participate in Preschool at NBCA.

FAMILY INFORMATION

PARENT 1

PARENT 2

GUARDIAN INFO

EMERGENCY CONTACT

HEAD START ELIGIBILITY FACTORS

Check all that apply.

ANNUAL INCOME

Please note, you are to bring a copy of your latest W2 or past 3 pay stubs to the school's office for income verification.

GSRP ELIGIBILITY FACTORS

Check all that apply.

Child is eligible for special education services or child's developmental progress is less than that expected for his/her chronological age, or chronic health issues cause development or learning problems.

Child has been expelled from preschool or child care center.

English is not spoken in the child’s home; English is not the child’s first language

Parent has not graduated from high school or is illiterate.

Domestic, sexual, or physical abuse of child or parent; child neglect issues. Child Protective Services report.

Parental loss due to death, divorce, incarceration, military services, or absence; sibling issues; teen parent (not yet age 20 when first child born); family is homeless or without stable housing; residence in a high-risk neighborhood (area of high poverty, high crime, with limited access to critical community services); or prenatal or postnatal exposure to toxic substance known to cause learning or developmental delays.

PROGRAM INFORMATION