Name of person filling out this application:
*
First Name
Last Name
Child’s full name:
*
First Name
Last Name
Name that child prefers to be called:
*
Pronouns:
*
Date of Birth:
*
MM
DD
YYYY
Languages spoken at home:
*
Name:
*
First Name
Last Name
Pronouns:
Relationship to child:
*
Home Phone:
*
(###)
###
####
Cell Phone:
(###)
###
####
Work Phone:
(###)
###
####
Email:
*
Address:
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation and employer:
*
Name:
First Name
Last Name
Pronouns:
Relationship to child:
Home Phone:
(###)
###
####
Cell Phone:
(###)
###
####
Work Phone:
(###)
###
####
Email:
Address
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Occupation and employer:
Please briefly describe your child (this may include any interests, temperament, their personality, behavior patterns, etc.).
*
Please describe your child’s social relationships (to their peers, adults, siblings, etc).
*
Please describe your child’s general health. Does your child have any medical needs that we should be aware of?
*
Has your child ever received supportive services; academic, emotional, physical, family or otherwise? Are there any aspects of your child’s development where you have questions or concerns?
What is your child doing when they are most happy? What kinds of activities do they not enjoy or struggle with?
*
Is there any further pertinent information we should know about the child’s parent(s)/caregiver(s) e.g, step parents involved in child's life, custody details, etc..
Number of children in the family:
*
Name, age, and school of siblings:
Are there other members of the household? Name and role/relationship:
Please describe your child’s home environment. This may include any activities you do as a family, how you approach discipline, how you experience media, how you spend free time together, balance work schedules, etc.
*
Is your child currently enrolled in preschool or childcare?
*
Yes
No
If so, where?
Contact information of preschool/caregiver:
If applying for a child who will be 5 years of age by October 15, 2024, has your child completed a Kindergarten screening?
Yes
No
If yes, where?
Date of screening?
MM
DD
YYYY
Is your child currently home schooled?
*
Yes
No
Please describe your child’s relationship to their preschool experience:
*
What do you hope your child will gain from attending The Community School?
*
Is there anything we haven’t asked about your child and/or your family that would be important for us to know upon receipt of the application and in preparation for your visit?
*
Buttons and zips clothing without help
*
Most of the time
Sometimes
Rarely / never/ not yet
Gets dressed without help
*
Most of the time
Sometimes
Rarely / never / not yet
Ties shoes without help
*
Most of the time
Sometimes
Rarely / never / not yet
Puts each shoe on correct foot
*
Most of the time
Sometimes
Rarely / never / not yet
Participates in daily routines or chores
*
Most of the time
Sometimes
Rarely / never / not yet
Brushes teeth without help
*
Most of the time
Sometimes
Rarely / never / not yet
Blows and wipes nose without being asked
*
Most of the time
Sometimes
Rarely / never / not yet
Takes care of bathroom needs independently
*
Most of the time
Sometimes
Rarely / never / not yet
Washes and dries hands when needed
*
Most of the time
Sometimes
Rarely / never / not yet
Wets or soils pants
*
Most of the time
Sometimes
Rarely / never / not yet
Wets bed
*
Most of the time
Sometimes
Rarely / never / not yet
Independently washes during bath or shower
*
Most of the time
Sometimes
Rarely / never / not yet
Picks up after self without being asked
*
Most of the time
Sometimes
Rarely / never / not yet
Wakes up and needs help going back to sleep
*
Most of the time
Sometimes
Rarely / never / not yet
Uses a fork, a spoon, or chopsticks correctly
*
Most of the time
Sometimes
Rarely / never / not yet
Spills food or drink when eating
*
Most of the time
Sometimes
Rarely / never / not yet
Unscrews bottle caps without help
*
Most of the time
Sometimes
Rarely / never / not yet
Opens snack or lunch containers without help
*
Most of the time
Sometimes
Rarely / never / not yet
Pours from a small can, carton or jar without spilling
*
Most of the time
Sometimes
Rarely / never / not yet
Pours dry cereal and milk into bowl without spilling
*
Most of the time
Sometimes
Rarely / never / not yet
Can follow safety rules (stays away from hot oven, fire, etc.)
*
Most of the time
Sometimes
Rarely / never / not yet
Acts without thinking (runs into the street without looking both ways, etc.)
*
Most of the time
Sometimes
Rarely / never / not yet
Wanders away from you in public places
*
Most of the time
Sometimes
Rarely / never / not yet
Responds to and makes verbal greetings at appropriate times (says “hi” or “good morning” if prompted by familiar person)
*
Most of the time
Sometimes
Rarely / never / not yet
Cooperates with peers during play
*
Most of the time
Sometimes
Rarely / never / not yet
Solves problems by negotiating with peers rather than hitting, pushing, or biting (taking turns, sharing, etc.)
*
Most of the time
Sometimes
Rarely / never / not yet
Uses kind words with others
*
Most of the time
Sometimes
Rarely / never / not yet
Asks before using other people’s things
*
Most of the time
Sometimes
Rarely / never / not yet
Breaks things (toys, other objects, etc.) on purpose
*
Most of the time
Sometimes
Rarely / never / not yet
Exhibits impulse control and self-regulation (uses appropriate words to show anger when a toy is taken by another child and shows some patience when waiting for their turn)
*
Most of the time
Sometimes
Rarely / never / not yet
Has tantrums (stamps feet, screams, etc.)
*
Most of the time
Sometimes
Rarely / never / not yet
Argues when denied their own way
*
Most of the time
Sometimes
Rarely / never / not yet
Makes transitions easily (moves easily from one activity to the next when asked, etc.)
*
Most of the time
Sometimes
Rarely / never / not yet
Understands and follows two step directions
*
Most of the time
Sometimes
Rarely / never / not yet
Speaks in complete sentences
*
Most of the time
Sometimes
Rarely / never / not yet
Interrupts others when speaking
*
Most of the time
Sometimes
Rarely / never / not yet
Smiles or laughs when something is funny
*
Most of the time
Sometimes
Rarely / never / not yet
Knows when people are happy or sad
*
Most of the time
Sometimes
Rarely / never / not yet
Shows concern for someone who is crying
*
Most of the time
Sometimes
Rarely / never / not yet
Stays calm when things do not go as planned
*
Most of the time
Sometimes
Rarely / never / not yet
Admits when they have made a mistake
*
Most of the time
Sometimes
Rarely / never / not yet
Blames others when bad things happen
*
Most of the time
Sometimes
Rarely / never / not yet
Shows pride in doing something well
*
Most of the time
Sometimes
Rarely / never / not yet
Gives up easily
*
Most of the time
Sometimes
Rarely / never / not yet
Whines or pouts
*
Most of the time
Sometimes
Rarely / never/ not yet
Goes to bed easily
*
Most of the time
Sometimes
Rarely / never/ not yet
Seems afraid of many things
*
Most of the time
Sometimes
Rarely / never/ not yet
Clings or hangs on to you
*
Most of the time
Sometimes
Rarely / never/ not yet
Will you be applying for financial aid?
*
Yes
No
Parent/Caregiver's Initials
*
Parent/Caregiver's Initials
Date
*
MM
DD
YYYY