Download the application form here or fill it out electronically below.
Name Of Preschool: FallWinterSpring Two (2) DaysThree (3) DaysFour (4) Days
Child's Name Date Of Birth Child's Age
Names of parents or other adults in home: Last Name First Name Middle Initial Phone Number Work Number Address
Last Name First Name Middle Initial Phone Number Work Number Address
Names and birth dates of minor children in home:
Last Name First Name Middle Initial Date Of Birth Child's Age
Total number of members in household
YOU MUST SUBMIT PREVIOUS YEAR COPIES OF W2S AND CURRENT AND LAST 30 DAYS OF EACH WAGE EARNER(S) EMPLOYER PAY SLIPS
Sources Of Income (Monthly) Adult Name Employer Name Monthly Income Employer Address Employer City Employer Zip Employer Phone Length Of Time Employed PermanentSeasonal
Adult Name Employer Name Monthly Income Employer Address Employer City Employer Zip Employer Phone Length Of Time Employed PermanentSeasonal
Other Sources Of Income:
DSHS Social Security/Disability Child Support Alimony
Do you receive other funding help for preschool or child? YesNo If yes, what is the monthly amount?
Do you receive income from any other source? YesNo If yes, what is the monthly amount?
Total Monthly Net Income
Parental Status Financial Information - check all that apply: Two Parent HouseholdSingle ParentSingle Parent Enrolled In SchoolFoster ParentsEnglish as a Second LanguageOther Adults In Home
Housing Status Satisfactory HousingTemporary HousingHomeless
Special medical needs of child (please list):
Please provide information on special circumstances not addressed in the previous sections.
If scans of your pay stubs are available, please upload them here.
If scans of your tax returns are available, please upload them here.
By submitting this form, I certify that all of the provided background and income information is true and correct and that all income is reported. All content is confidential and is only used for the purpose of granting preschool scholarship.
Applicant Name Applicant Email Applicant Phone Number
I would like to become involved with the Family Umbrella Group as a: Board MemberVolunteer