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Indian River School District
Early Learning
Early Learning Center
application
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
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2 most recent pay stubs
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W-2's
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Income Tax Form 1040
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TANF documentation
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Unemployment
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Written statements from employers
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SSI documentation
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*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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