* Required


SCOE Preschool Eligibility Screening

Parent or Guardian Information

Include yourself ​​​​
Ex: 555-555-5555​​​​​​​​
Ex: 555-555-5555​​​​​​​​
Ex: 555-555-5555​​​​​
Email required for confirmation information​​.​​​​​​​​​


Family Income: Please select the source and note the total monthly amounts for both adults listed in the above section.

Include: Employment, Child Support, Disability, Unemployment, TANF, Foster Care, Child Support/Alimony.​​​​​​​​​​​​
Enter total gross monthly income​​​​​​​​​​​

Children: Please list all children living in the home beginning with the youngest.

Comments/Questions/Important Information​​​​​​​​​