Preschool Promise Interest Form Name * First Name Last Name Email * Phone (###) ### #### Primary language spoken * English Spanish Arabic Somali Other Other language spoken? Monthly income * How many live in the household? * Child's information Child's Name * First Name Last Name Child's Date of birth * MM DD YYYY Child's primary language * English Spanish Arabic Somali Other Do you need transportation? * Yes No Do you need after school care? * Yes No Do you need care for an infant or toddler also? * Yes No How did you hear about us? * Google search Flyer on my door Teacher recommendation - Tiesha Teacher recommendation - Nadege Teacher recommendation - Alicia Teacher recommendation - Lorraine Teacher recommendation - Fatma Teacher recommendation - Deynabo Teacher recommendation - Hadiatu Teacher recommendation - Shimaa Teacher recommendation - Shanta Teacher recommendation - Shaymaa Washington county Hub Facebook Other Other place you heard about us? Please complete the full Preschool Promise application online. You will be redirected to the application page once you click submit. http:// Thank you!
