MCISD Early Childhood Program Inquiry Form

Inquiry/Pre-Application for Countywide Early Childhood Programs



MCISD Countywide Early Childhood Programs Inquiry/Pre-Application
Your child may be eligible for a variety of early childhood programs located in Monroe County. The following information will assist us in determining for which programs your child may be eligible for.
Sex:  (required)
Ethnicity/Race (check all that apply):  (required)
Resident School District:  (required)
Each of the preschool programs represented in this inquiry form has specific criteria for enrollment. Your child may not be eligible for the program you have inquired about, but may be eligible for different programs. We will for- ward this preliminary information. By signing this release you grant that records may be released or received by the following agencies: Monroe County Head Start Preschool/Early Head Start, Great Start Readiness Program, Early Childhood Special Education, Child Care Network, Early On, Other early childhood opportunities
The following information will allow the MCISD Early Childhood Team place your child in the best program to fit their needs.
Help for Family Income (Information required to be considered for State or Federally funded preschool programs). Please include child support, if applicable, in this figure: Annual Income:
Please check all that apply:
Receiving DHS - cash assistance  (required)
Receiving SSI (social security income)?  (required)
Diagnosed disability or identified developmental delay  (required)
Family is homeless or without stable housing  (required)
Child is in foster care  (required)
Can you drive your child to and from school?
Thank you for completing the MCISD Early Childhood Inquiry form. This information will be reviewed by the MCISD Early Childhood Team. Once reviewed, you will be contacted to discuss the program that best fits the needs of your family. If you have further concerns, please feel free to contact the MCISD Early Childhood Team at 734.342.8780 or
Security Check - To verify you are not a robot, please answer this question: