Program you want to apply for*

Time slots for Tuition ONLY

(excluding HTE)*

Student's Name*

Student's Demographics*

Is your child currently enrolled in an Early Learning Program*

Parent/Guardian Name*

Parent/ Guardian Demographic*

Current Address*

Phone Number*

Email Address*

Family Demographics*

Income Verification

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

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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*