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School Readiness Interest Form

Please complete the form below. Required fields marked with an asterisk *

Please Select Year to Enroll*

Answer required for "Please Select Year to Enroll"

2025-26 Current Year

Child's Name*

Nombre de su hijo/a

Answer required for "Child's Name"

Child's D.O.B*

Fecha de nacimiento

Answer required for "Child's D.O.B"

Parent's Name*

Nombre de Padre/Madre

Answer required for "Parent's Name"

Phone Number*

Numero de teléfono

Number Required

Parent Email*

Correo electrónico de los padres

Answer required for "Parent Email"

Street Address*

Domicilio

Answer required for "Street Address"

Apt Number

Apartamento

Answer required for "Apt Number"

City*

Ciudad

Answer required for "City"

Zip/Postal*

Codigo Postal

Answer required for "Zip/Postal"

Family Size*

Numero de miembros de familia

Answer required for "Family Size"

Home Language*

Idioma del hogar

Answer required for "Home Language"

Since our program is state funded, gross monthly income verification is required.

Dado que nuestro programa está financiado por el estado, se requiere la verificación del ingreso bruto mensual.

Gross Monthly Income*

Ingreso mensual en bruto

Answer required for "Gross Monthly Income"

Are you receiving benefits from any government program such as Cash Aid, Medi-Cal, CalFresh, CalWorks, or others?*

¿Está recibiendo beneficios de algún programa gubernamental como Cash Aid, Medi-Cal, CalFresh, CalWorks u otros?

Answer required for "Are you receiving benefits from any government program such as Cash Aid, Medi-Cal, CalFresh, CalWorks, or others?"

Yes / sí

Does the child you wish to enroll have an Individualized Family Support Plan (IFSP) or an Individualized Education Plan (IEP)*

¿El niño que desea inscribir tiene un Plan de Apoyo Individualizado (IFSP) o un Plan Educativo Individualizado (IEP)?

Answer required for "Does the child you wish to enroll have an Individualized Family Support Plan (IFSP) or an Individualized Education Plan (IEP)"

Yes / sí

Next Steps

A School Readiness Office member will contact you, the parent/guardian, to schedule an appointment to obtain/verify the following pre-enrollment eligibility requirements:

Original Birth Certificate - Required for all children claimed under your income
Proof of Residency - Utility bill or rental/lease agreements
Proof of Income - Paycheck stubs for the previous month for both parents
Student Immunization Records - Up to date
Recent Physical Exam - Signed and Stamped by Doctor (please see enrollment page for correct form)

If you have any questions about the enrollment process please call (714) 527-2154.

Próximos pasos

Un miembro de la oficina de School Readiness se comunicará con usted, padre/tutor, para programar una cita y obtener o verificar los siguientes requisitos de elegibilidad de pre-inscripción:

Certificado de nacimiento original: Obligatorio para todos los niños reclamados bajo sus ingresos
Prueba de residencia: Factura de servicios públicos o contratos de renta
Comprobante de ingresos: recibos de sueldo del mes anterior para ambos padres
Registro de vacunación de los estudiantes: Actualizados
Examen físico reciente: Firmado y sellado por el médico (consulte la páginia de inscripcíon para obtener el formulario correcto)

Si tiene alguna pregunta sobre el proceso de inscripción por favor llame al (714) 527-2154.