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Online Pre-K Counts Scholarship Application
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COVID-19 Mitigation Plan
Contact
ABOUT
Executive Director’s Welcome
Faculty & Staff
Our Approach
Campus
Nutrition
Careers
Resources
FAQs
PROGRAMS
Overview
Infant
Toddler
Preschool
Pre-Kindergarten
School Age
Summer Camps
ENROLLMENT
Tuition & Scholarship Information
Pre-K Counts Scholarship Application
Schedule a Tour
Contact
PARENTS
TEACHERS
COVID-19 Mitigation Plan
ABOUT
Executive Director’s Welcome
Faculty & Staff
Our Approach
Campus
Nutrition
Careers
Resources
FAQs
PROGRAMS
Overview
Infant
Toddler
Preschool
Pre-Kindergarten
School Age
Summer Camps
ENROLLMENT
Tuition & Scholarship Information
Pre-K Counts Scholarship Application
Schedule a Tour
Contact
PARENTS
TEACHERS
COVID-19 Mitigation Plan
Pre-K Counts Scholarship Application
Pre-K Counts Scholarship Application
Filling out an application for a Pre-K Counts Scholarship is now easier than ever! You can fill out the application here on laptops, desktops or mobile devices.
"
*
" indicates required fields
Date Form is Completed
*
MM slash DD slash YYYY
Child's Name
*
First
Middle
Last
Child's Age as of September 1, 2022
*
3 Years Old
4 Years Old
5 Years Old
Household (Family) Size
*
Primary Language
*
English
Spanish
Preferred Classroom Session
8:30 a.m. - 3:00 p.m.
9:00 a.m. - 3:30 p.m.
No Preference
Family Type
*
One Parent
Two Parents
Foster Child
Child Living With Relative
Is there a court order for custody?
*
Yes
No
If there is a custody order, who has legal custody?
Certified court orders must be provided.
If applicable, upload the certified court order here.
Max. file size: 256 MB.
Name of parent completing the application
*
First
Last
Email of the parent completing the application
*
Address of the parent completing the application
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
County of the parent completing the application
*
Cell Phone
*
Work Phone
Home Phone
School district the child will attend
*
Altoona Area School District
Bellwood Antis School District
Hollidaysburg Area School District
Spring Cove School District
Elementary school the child will attend
*
Baker Elementary School
Mowrie A Ebner Elementary School
McAuliffe Heights Program at Irving School
Juniata Elementary School
Juniata Gap Elementary School
Logan Elementary School
The STEAM Learning Center at Penn-Lincoln
Pleasant Valley Elementary School
Myers Elementary School
Charles W. Longer Elementary School
Frankstown Elementary School
Foot of Ten Elementary School
Spring Cove Elementary School
Martinsburg Elementary School
Child's gender
*
Male
Female
I certify that I am a legal resident of Pennsylvania
*
Yes, I am a legal resident of Pennsylvania
Signature
If you are able to print this form, sign in this box.
Signature
Max. file size: 256 MB.
If you cannot print this form to sign it, you can take a picture of your signature with the words "Begin With Us Signature" in the picture and upload it here.
Household Yearly Income
*
Less than $5,000
$5,001 - $10,000
$10,001 - $15,000
$15,001 - $$20,000
$20,001 - $25,000
$25,001 - $30,000
$30,001 - $35,000
$35,001 - $40,000
$40,001 - $45,000
$45,001 - $50,000
$50,001 - $55,000
$55,001 - $60,000
$60,001 - $70,000
$70,001 - $100,000
More than $100,000
The person completing this application must attach copies of documents used to verify income with submission of application. Applications submitted without income will be considered incomplete.
Income includes: Earned income: gross wages from work/cash-in-hand/self-employment. Unearned income: alimony, child support, military family allotments, pensions, public assistance, Supplemental Security Income (SSI). Unearned benefits: worker's compensation, unemployment, lottery winnings, retirement benefits.
Income verification: pay stubs, W-2s, Internal Revenue Service tax forms, or written employer statement of anticipated earnings. Self-employment: tax returns, business records. Benefit check, bank statement, court order.
Income Verification Upload
Drop files here or
Select files
Max. file size: 256 MB.
Federal Poverty Guidelines
I have reviewed the federal poverty guidelines.
Please check all boxes that pertain to your family:
Family income is at or below 300% of federal poverty level. (Required risk factor for enrollment.)
Consider all sources of income as listed above. Income will be reviewed and verified prior to enrollment.
Other Child Eligibility Risk Factor Criterion (Must check all that apply. Verification is required for each risk factor identified.):
Behavioral or Health Support Services:
A child who was referred from an appropriately credentialed health or mental health practitioner who is not employed by the Pre-K Counts program; a child who is receiving mental health treatment.
Child Protective Services:
A child who is a foster child, a kinship care child, or receiving Children, Youth and Family services.
Education Level of Guardian:
Parent/Guardian does not have or is in the process of obtaining a high school diploma or post-secondary degree.
English Language Learner:
A child whose first language is not English and who is in the process of learning English is considered an English Language Learner.
Teen Mother:
A child whose mother was under the age of 18 when the child was born.
Individualized Education Program (IEP):
A child who is currently enrolled in the preschool early intervention program with an active Individualized Educational Program (IEP). Verification would be a copy of the IEP or other source of documentation from the parent or early intervention provider.
Homeless:
A child who lacks a fixed, regular, and adequate nighttime residence due to one of the following: A- A child who is sharing the housing of other persons due to loss of housing, economic hardship, or a similar reason; is living in motels, hotels, or camping grounds due to the lack of alternative accommodations; is living in emergency or transitional shelters; is abandoned in hospitals; or is awaiting foster care placement; B- A child who has a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings; C- A child who is living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings.
Migrant: (Non-Immigrant)/Seasonal Student:
A migrant child has moved from one school district to another in order to accompany or to join a migrant parent or guardian, who is a migratory worker or migratory fisher, within the preceding 36 months, in order to obtain temporary or seasonal employment in qualifying agricultural or fishing work including agricultural-related businesses such as meat or vegetable processing, working in nurseries such as Christmas and evergreen trees farming.
Incarcerated Parent:
A child, of which: one of the child's parents is currently incarcerated.
If you marked "Incarcerated Parent" above, please enter the possible release from prison date:
MM slash DD slash YYYY
Have you applied for any other sources of funding or to any other agencies for the 2022-2023 school year, including but not limited to: Pre-K Counts, Head Start, Early Learning Resource Center (formally known as Child Care Information Services (CCIS), scholarships, etc.?
*
Yes
No
If you answered yes to the previous questions, please list all:
Do you anticipate needing child care before or after the school day?
*
Yes
No
If you anticipate needing child care before and/or after, please specify:
Before Care
After Care
Both
Neither
How did you hear about our program?
*
Internet Search/Website
Newspaper Advertisement
Facebook Advertisement
Recruiting Event
Billboards
Lives/Works Nearby (Location)
Friend/Relative
If you heard about us from a friend or relative, please specify who:
Please check this box to verify that you have completed this application with accurate information:
*
To the best of my/our knowledge, the information provided is accurate. I/We understand that I/we will be asked to verify or substantiate the information provided.
This application will be considered incomplete if not submitted with proof of income and verification of any additional child risk factor criterion.
Please print parent/legal guardian's name:
*
Date
*
MM slash DD slash YYYY
Signature
If you are able to print this form, sign in this box.
Signature
Max. file size: 256 MB.
If you cannot print this form to sign it, you can take a picture of your signature with the words "Begin With Us Signature" in the picture and upload it here.
Please print parent/legal guardian's name:
Date
MM slash DD slash YYYY
Signature
If you are able to print this form, sign in this box.
Signature
Max. file size: 256 MB.
If you cannot print this form to sign it, you can take a picture of your signature with the words "Begin With Us Signature" in the picture and upload it here.
Congratulations, you are considering one of the most valuable experiences for your child that is available in early childhood education today. Begin With Us will provide your child with a strong foundation for learning with passionate teachers, hands on experiences, and developmentally appropriate curriculum. We encourage you to learn more about our program and your place as a parent in our learning community through our website: www.beginwithus.net
In order to better allow us to get to know your child, please complete the following four (4) questions:
Why would you like for your child to receive a scholarship?
*
Please tell us about your child's strengths; and areas where a high quality early learning program would benefit your child.
*
Why would begin with us be a good fit for your child?
*
What do you think your child will like the most about attending begin with us?
*
Office Use Only
Staff Verifying Income and Risk Factors Signature
Date
MM slash DD slash YYYY
Staff Verifying Income and Risk Factors Signature
Date
MM slash DD slash YYYY
Actual Annual Verified Gross Household (Family) Income:
Please include the date and signature of he parent or guardian to document that any family who is Head Start income eligible (100% of FPL or below) has been informed of their eligibility. The staff person that informs the parent/guardian must sign below.
If applicable, please ensure the parent/guardian signs and dates.
If applicable, the staff should sign and date above.
If applicable, the staff should sign and date above.
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