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Early Learning Center
Program you want to apply for*
Programa al que desea*
Student's Name*
Nombre del Estudiante*
Student's Demographics*
Información sobre el estudiante*
Is your child currently enrolled in an Early Learning Program*
¿Su hijo está actualmente inscrito en un programa de aprendizaje temprano? *
Parent/Guardian Name*
Nombre de Padre/Guardian*
Parent/ Guardian Demographic*
Información del Padre*
Are you a Indian River School District Employee?*
¿Es usted un empleado del distrito escolar de Indian River? *
Current Address*
Dirección actual* 
Phone Number*
Numero de telefono*
Email Address*
Correo electrónico*
Family Demographics*
Informacion de la familia*
Income Verification
Verificacion de Ingresos
Depending on the program choice, parents will be asked to submit one income documentation 
  • 2 most recent pay stubs                                                     
  • W-2's
  • Income Tax Form 1040
  • TANF documentation
  • Unemployment
  • Written statements from employers
  • SSI documentation

*I verify that the information that I have submitted is true and correct, I understand that I might be asked to verify this information*

In order for your application to be considered, ASQ screenings must be completed!

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