Madison City Schools First Class Pre-K Online Application
Children must be four years old on or before September 1st, 2016. Copies of the following documents are required: age verification document (for example: birth certificate, passport, official documents from other countries), proof of residency.
Student's Full Name*
First Name Middle Name Last Name
Student's Date of Birth*
Month Day Year
Gender*
Primary Custodial Parent/Guardian*
Prefix First Name Middle Name Last Name
Address*
Street Address
Street Address Line 2
City State / Province
Postal / Zip Code Country
Home Phone
Area Code Phone Number
Cell Phone
Area Code Phone Number
Work Phone
Area Code Phone Number
Contact E-mail
Child physically resides with*
Mother and Father Mother Father Grandparent Other
# of Persons in Household*
Language Spoken at Home*
English Spanish Other
Other Language*
What is the student's race?*
American Indian or Alaska Native Asian Black or African American Hispanic White
Highest Education In Household*
Family's Combined Annual Income*
Do you receive public assistance?
Yes No
If yes, please select type of assistance*
SSI Disability WIC Food Stamps TANF Other
Other Assistance
Should be Empty: