Lamoille North Supervisory Union PK Returning Students 2023-24

Is your child already registered though Lamoille North School District AND are you looking for placement after August 27, 2023?*

Yes No

Please fill out all required fields below.

Registering your child on this form does not guarantee them a spot in one of the LNSU school based classrooms. You must attend a screening at your local school.

Do not use this form. This form is only for current PreK students who will be returning next year.

Student Information

Student Legal First Name required

Student Legal Middle Namerequired

Student Legal Last Namerequired

Student DOB:required

Legal Gender*

M F

Expected Enrollment Daterequired (mm/dd/yyyy)

Permission is granted for the school to bill Medicaid for my special education student.

Yes No

We are requesting that my Pre K child be enrolled in*

A Community Partner Pre-K Program Cambridge Elementary Pre-K Eden Central School Pre-K Hyde Park Elementary Pre-K Johnson Elementary Pre-K Waterville/Belvidere Elementary Pre-K

Act 166: Universal Prekindergarten Tuition Request Form 2022-2023 School Year

Winooski Valley Superintendents Association (WVSA) Universal Preschool Region

Barre Unified Union School District	Central Vermont Supervisory Union
Harwood Unified Union School District	Lamoille South Unified Union
Lamoille North Supervisory Union	Montpelier Roxbury School District
Orange Southwest School District	Orleans Southwest Supervisory Union
Washington Central Unified Union School	White River Valley Supervisory Union

To be eligible for Universal Preschool/Act 166 funding children must be 3, 4, or 5 years of age on or before September 1st. The child may remain enrolled at their early education center at age 6; however, access to Act 166 Tuition will stop on the child’s birthday. Children enrolled in Act 166 may not also be enrolled in Kindergarten.

The WVSA region has entered partnerships with many community early childhood programs. To participate in Universal Preschool/Act 166 an early childhood program must be prequalified by the Agency of Education (AOE). If your child’s early childhood program is not yet qualified, encourage them to reach out to the early education team at the Agency of Education. If your child is attending both a public school and a community program the funding is applied to the public school location.

You are required to complete the registration process with your school district. Under the criteria that an early childhood program must meet, as verified by the AOE, programs must:

● Be in compliance with Child Development Division Licensing Regulations.

● Participate in the State’s Step Ahead Recognition System at state determined level* currently under redesign

● Use Vermont’s Early Learning Standards (VELS) to plan curriculum

● Employ or contract with an AOE licensed teacher with either an Early Childhood or Early Childhood Special Education endorsement

● Assess and monitor PreK student progress using the online Assessment System Teaching Strategies Gold (TSG).

● Provide parents or guardians and AOE with a report of a child’s developmental progress at least twice per year and offer parents/guardians two opportunities per year to meet with the teacher

● Operate a minimum of 10 hours per week and 35 weeks during the academic year

● Adhere to all applicable federal and state laws.

● For children receiving early childhood special education services who are enrolled in the prekindergarten program, allow access to early childhood special education service providers:

● Assure to adhere to and report child incident data on restraint and seclusion requirements

● Adhere to and report child incident data on suspension and expulsion requirements

● Accept and educate students without discrimination based on gender, race, nationality, disability, economic status, religion, or parental marital status. ● Accept and educate students without discrimination based on toilet learning. ● Assure to permit on-site visits announced and unannounced, representatives from the Agency of Education, the Department for Children and Families, and partner School District Staff

We are requesting that my Pre K child be enrolled in the following school/program:

I agree to complete the registration process with my resident school district, which includes proof of residency and proof of age.

This includes proof of residency and proof of age. Schools will provide up to $3,764 per school year to one pre-qualified pre-kindergarten provider if the child’s registration is complete before the start of the school year. I understand that my child’s tuition will be prorated based on the date that I fully complete registration and/or update the information if my child was enrolled last year. (10 hours per week for 35 weeks).

Yes No

I agree to follow the attendance policy provided by the prekindergarten program and ensure that my child attends pre kindergarten consistently.

I understand it is my responsibility to notify the Supervisory Union/Supervisory District if we move or if my child stops attending pre-kindergarten or changes programs.

Yes No

I agree to authorize the release of information between my child’s prekindergarten program to communicate with my school district about my child’s development, enrollment, attendance, registration and suspension/expulsion.

Yes No

Parent/Contact 1 Information

Parent/Guardian 1 Legal First and Last Name:required

Parent/Guardian 1 Email Addressrequired

Parent/Guardian 1 Home Number:required

Parent/Guardian 1 Mobile Numberrequired

SMS mobile phone?

Yes No

Parent/Guardian 1 Mailing Address (if different from Physical Address)required

How is this Parent/Guardian1 related to the student? (Mother, Father, etc.)required

Parent/Guardian 1 has custody?*

Yes No

Student lives with Parent/Guardian 1*

Yes No

Is there a second parent/legal guardian?*

Yes No

Parent/Guardian 2 Information

Parent/Guardian 2 Legal First and Last Name:

Parent/Guardian 2 Email Address

Parent/Guardian 2 Home Number:

Parent/Guardian 2 Mobile Number

Parent/Guardian 2 Mailing Address (if different from Physical Address)

How is this Parent/Guardian2 related to the student? (Mother, Father, etc.)

Parent/Guardian 2 has custody?

Yes No

Student lives with Parent/Guardian 2

Yes No

Parent/Guardian 2 may pick up from school?

Yes No

Is there an emergency contact in case a parent/guardian listed above cannot be reached?*

Yes No

Emergency Contact 1

Emergency Contact 1 Name

Emergency Contact 1 Phone Number

Does this person have permission to pick your child up from school?

Yes No

Is there a second emergency contact?

Yes No

Emergency Contact 2

Emergency Contact 2 Name

Emergency 2 Contact Number

Does this person have permission to pick up your child from school?

Yes No

Authorized Signature

Your typed name below serves as a signature certifying the accuracy of the above informationrequired

I acknowledge that I have read and agree with the information provided in this document.

Date required (mm/dd/yyyy)

Please Note:

After this form is submitted, you will receive an immediate automated acknowledgement. It will then be handled by our Director of Early Childhood Education, Melinda Mascolino.

Please send a confirmation email to the address below:

Please provide an email address where we can send a link to your current form.

Email Address :