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Collierville Schools: Voluntary Pre-K Application

Collierville School LogoVoluntary Pre-K Application

2020-2021 

Thank you for your interest in Voluntary Pre-K!  Voluntary Pre-k screening scheduled for May 4 and may 5 has been cancelled due to our town being under a Safer-At-Home order.  Screening will be completed electronically by completing this form.

The Voluntary Pre-K Program is designed to meet the needs of students identified as economically at-risk (low-income). 

Applicants must reside in Collierville, TN and be 4 years of age on or before August 15, 2020.

Please see below for a complete list of documents needed to complete the application.  Once you begin the application process, you will not be able to save in progress so it is important to have all documents accessible.     

  1. Child’s Certified Birth Certificate 
  2. Child’s Social Security Card 
  3. Child’s Physical and Immunization Record on a Tennessee School Form 
  4. Two (2) Proofs of Residence – Examples may include:  driver's license, public/government benefits or assistance, sales contract (contingency agreements not accepted), real estate tax receipt, mortgage information, current MLGW bill or turn on receipt, municipal water bill, rental or lease contract. *Shared residents will have to be approved in person at a later date.
  5. Proof of Income for all adults in the household – Proof of Income and/or status of current month's salary must be documented for all who work in household (check stubs, W-2, income tax returns, letter of termination, unemployment eligibility, federal assistance eligibility letter) 
  6. Parent’s Photo ID  
  7. If applicable, documents related to special services: IEP (Individualized Education Program), OT (Occupational Therapy), PT (Physical Therapy), Speech, documents, etc. 

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

Child's Information:

Gender:*
Answer Required
Race:*
Please choose one or more
Answer Required
Does your child have an Individualized Education Program (IEP) or 504 plan?*
Answer Required
Has your child ever been enrolled in a Tennessee School?*
Answer Required
Is the above address a shelter or temporary living situation?*
Answer Required
Has your child received early intervention services in the home or at a center?*
Answer Required
Has your child been evaluated or in the process of being evaluated for special education services?*
Answer Required
Does your child receive any of the following services?*
Please select all that apply.
Answer Required
Do you have speech concerns for your child?*
Answer Required
Has your child been enrolled in preschool?*
Answer Required

Family Information:

Family Status:*
Answer Required
Employment Status - 1st Parent/Legal Guardian:*
Answer Required
Employment Status - 2nd Parent/Legal Guardian:*
Answer Required
Are you receiving WIC?*
Answer Required
Are you receiving Families First (TANF)?*
Answer Required

Required Document Uploads:  

Upload your child's Birth Certificate:*
Upload your child's birth certificate. (Mother's Copy is not accepted.)
Answer Required
or drag it here.
Upload your child's social security card:*
Answer Required
or drag it here.
Upload your child's Physical and Immunization Record:*
This document should be on a Tennessee form.
Answer Required
or drag it here.
Upload Two (2) Proofs of Residence Documents below:*
Examples may include: driver's license, public/government benefits or assistance, sales contract (contingency agreements not accepted), real estate tax receipt, mortgage information, current MLGW bill or turn on receipt, municipal water bill, rental or lease contract.
Answer Required
or drag it here.
Upload Income Documents - 1st Parent/Legal Guardian:*
Proof of Income and/or status of current month's salary must be documented for all who work in household (check stubs, W-2, Income tax returns, letter of termination, unemployment eligibility, Federal assistance eligibility letter)
Answer Required
or drag it here.
Upload Income Documents - 2nd Parent/Legal Guardian:
Proof of Income and/or status of current month's salary must be documented for all who work in household (check stubs, W-2, Income tax returns, letter of termination, unemployment eligibility, Federal assistance eligibility letter)
Answer Required
or drag it here.
Upload Driver's License - 1st Parent/Legal Guardian:*
Answer Required
or drag it here.
Upload Driver's License - 2nd Parent/Legal Guardian:
Answer Required
or drag it here.
Upload documents related to special services:
*If you receive services through Collierville Schools, you do not need to upload documents. If applicable, please upload documents related to special services: IEP (Individualized Education Program), Occupational Therapy (OT), Physical Therapy (PT), Speech, and etc.
Answer Required
or drag it here.

Voluntary Pre-K Program Choices:

VPK programs are housed at the following schools:  

  • Collierville Elementary School
  • Schilling Farms Elementary School
Select the school your child is currently zoned to attend. *
Answer Required
Parent/Legal Guardian Agreement:*
Read and select each item to acknowledge your agreement.
Answer Required
Confirmation Email
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