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2022-23 VPK Three-Year-Old Waitlist

Voluntary Pre-Kindergarten Information

Hello and welcome to the Voluntary Pre-Kindergarten informational page and application. Thank you for your interest! Collierville Schools is currently waiting for state funding, determined by the Tennessee Department of Education, for Voluntary Pre-K. Once the state has announced its grant recipients, Collierville Schools will know how many Voluntary Pre-K classrooms we are permitted.

Voluntary Pre-K is an educational program that school districts may apply for on an annual basis and is funded by state and local funds. The purpose of the program is to provide your four-year-old child(ren), identified as being educationally and economically at-risk, with the access to a quality educational environment, in hopes of preparing he or she for future educational success. The program is of no cost to the parent(s)/caregiver(s).

In the event that programs are not filled with income-eligible four-year-old children, we are accepting three-year-old children to be on a waitlist. Please fill out the application below to be considered.

Please complete the form below for the 2022-23 VPK application. Required fields are marked with an asterisk.*

2022-23 VPK Three-Year-Old Application

Child's Information:

Please Date:*

Answer Required

Child's Last Name:*

Answer Required

Child's First Name:*

Answer Required

Child's Middle Name:*

Answer Required

Gender:*

Answer Required

Male

Female

Child's Date of Birth:*

Answer Required

What grade will your child enter during the 2022-23 school year?*

Please enter pre-k.

Answer Required

Home Address:*

Include: House #, Street Name, Cite, State and Zip Code

Answer Required

Race:*

Please choose one or more

Answer Required

Asian

Black/African American

Caucasian

Hispanic/Latino

Pacific Islander

Other:

Parent's Name:*

*This parent will be contacted to inform applicants of information pertaining to the VPK program.

Answer Required

Primary Phone Number:*

This number will be used to inform applicants of information pertaining to the VPK program.

Answer Required

Primary Email:*

*This email will be used to inform applicants of information pertaining to the VPK program.

Answer Required

Does your child have an Individualized Education Program (IEP) or 504 plan?*

Answer Required

Yes

Has your child ever been enrolled in a Tennessee School?*

Answer Required

Yes

If your child has been enrolled in a Tennessee school, please list the school below.

Answer Required

Child's Social Security Number:*

Ex: 123-45-6186

Answer Required

Is the above address a shelter or temporary living situation?*

Answer Required

Yes

Has your child received early intervention services in the home or at a center?*

Answer Required

Yes

Has your child been evaluated or in the process of being evaluated for special education services?*

Answer Required

Yes

Does your child receive any of the following services?*

Please select all that apply.

Answer Required

Occupational Therapy (OT)

Physical Therapy (PT)

Speech

Tennessee Early Intervention System (TEIS)

My child does not receive any of the above services.

My child currently has an Individualized Education Plan (IEP)

Please provide a brief description of the above mentioned services your child receives.*

Example: Location and frequency of services - Please type N/A if Not Applicable

Answer Required

Do you have speech concerns for your child?*

Answer Required

Yes

Please provide a brief description of your concerns regarding speech. *

Please type N/A is Not Applicable.

Answer Required

Has your child been enrolled in preschool?*

Answer Required

Yes

Please give the name of the preschool your child has attended.*

Answer - N/A - for not Not Applicable

Answer Required

Family Information:

Name - 1st Parent/Legal Guardian *This parent will be contacted to inform applicants of information pertaining to the VPK program.*

Answer Required

Social Security Number of 1st Parent/Legal Guardian*

Example: 123-45-6186

Answer Required

Name - 2nd Parent/Legal Guardian:*

Include: First, Middle ad Last Name. (N/A if Not Applicable)

Answer Required

Number in Family:*

Answer Required

Number in Household:*

Answer Required

Family Status:*

Answer Required

Two Parent Home

Single Parent Home

Foster Home

Shared Residences

Homeless

Employment Status - 1st Parent/Legal Guardian:*

Answer Required

Employment Status - 2nd Parent/Legal Guardian:*

Answer Required

Gross Monthly Income - 1st Parent/Legal Guardian:*

Monthly income, before taxes - (ex. : $2,000 etc)

Answer Required

Gross Monthly Income - 2nd Parent/Legal Guardian:*

Monthly Income, before taxes - (ex. $2,000 etc) or N/A if Not Applicable

Answer Required

Please enter Gross Monthly Income - Combined:*

1st Parent + 2nd Parent = Combined ($2,000 + $2,000 = $4,000

Answer Required

Are you receiving WIC?*

Answer Required

Yes

Are you receiving Families First (TANF)?*

Answer Required

Yes

Please provide your WIC/Families First (TANF) case numbers. *

Please enter N/A if Not Applicable.

Answer Required

List the name, school and grade of ALL OTHER children living in the household for the 2022-23 school year.*

Do not include the applicant. Example: John Smith, Schilling Farms Elementary, 2nd grade

Answer Required

List the name and relationship to the applicant of ALL OTHER adults living in the household.*

Example, Tom Shields - Dad, Sue Shields - Grandmother

Answer Required

Emergency Contact #1 Information:*

Please enter as follows: Last name, first name, phone number

Answer Required

Emergency Contact #2 Information:*

Please enter as follows: Last name, first name, phone number

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