Learning Center Registration Learning Center Questionaire
Marcellus Learning Center
Preschool Registration Packet
The Marcellus Learning Center is a half day preschool program for children who turn four years of age before December 1 st of the program year. Classes are held Monday through Thursday with both morning and afternoon sessions.
The main focus of the Marcellus Learning Center Preschool is to invoke in children a positive attitude towards school. Children are introduced to a daily school routine which is developmentally appropriate for four year olds. Activities revolve around themes which are generated by the children’s interests. One field trip a month is planned to give children first hand learning experiences related to our themes.
State funding provides money for 36 children to attend. Children are chosen on basis of need. Need is not determined exclusively by income. Living in a rural community is an example of a qualifying factor. Home interviews determine need through a variety of factors. Children must meet at least three criteria of need in order to be considered for the state funded openings. Children who qualify for Head Start are not eligible for the state funded program.
The Marcellus Learning Center is a half day preschool program for children who turn four years of age before December 1 st of the program year. Classes are held Monday through Thursday with both morning and afternoon sessions.
The main focus of the Marcellus Learning Center Preschool is to invoke in children a positive attitude towards school. Children are introduced to a daily school routine which is developmentally appropriate for four year olds. Activities revolve around themes which are generated by the children’s interests. One field trip a month is planned to give children first hand learning experiences related to our themes.
State funding provides money for 36 children to attend. Children are chosen on basis of need. Need is not determined exclusively by income. Living in a rural community is an example of a qualifying factor. Home interviews determine need through a variety of factors. Children must meet at least three criteria of need in order to be considered for the state funded openings. Children who qualify for Head Start are not eligible for the state funded program.
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Marcellus Learning Center/Preschool
Student Registration Form
Name________________________________________________Date_____________________
Last First M.I.
Birthdate_________________ Birthplace___________________ Sex: M or F
Race: American Indian African American Asian/Islander Caucasian Other
Student’s Social Security Number______/______/______
Address_______________________________________________________________________
Street # Street Name Apt.-Box-Lot # County
_____________________________________________________________________________________________
City State Zip Township
Home Telephone (269)_______________ Unlisted?____ Work Telephone________________
Emergency Contact Person_______________________________Relationship:______________
Emergency Number________________ Unlisted?_____ Home Language______________
Is your child currently enrolled in a preschool program? Y or N Where?_______________
Has your child attended Head Start? Y or N On waiting list________________________
Has your child ever been referred for special services? (Please specify)____________________
Parent Information |
Mother |
Father |
Guardian/Step-parent |
Name |
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Address |
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Place of Birth |
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Language in Home |
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Date Naturalized |
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Educational Status |
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Occupation |
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Marital Status |
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Step-parents(s) |
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Child Resides With |
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Name of Employer |
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Employer’s Phone # |
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Hours You Work |
Household Roster: Please list all members residing in your household.
Name of Individual |
Age |
Birthdate |
Sibling living outside of the home under 21 |
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PROOF OF IMMUNIZATION IS REQUIRED AND DATES MUST BE PROVIDED:
Waiver forms are available in each school if you object to immunization for medical or religious reasons. A State copy of your child’s birth certificate is required.
Our district has a policy regarding student records in compliance with the Family Educational Rights and Privacy Act (FERPA). Information relative to FERPA is printed annually in the local newspaper. A copy of this policy can be obtained upon request to the building principal.
I certify the above statements are true to the best of my knowledge. I also authorize the sharing of this information with other local agencies as deemed necessary.
Date____________________Signature_______________________________________
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Marcellus Learning Center/Preschool
Question Form
Student Name:_______________________________________________________ Date___________________________
Do you believe your child has a special need? Please check your concerns from the following:
______ 1. Behavior Problems – tantrums; is not able to accept limits; resists rules or refuses to comply with requests.
______ 2. Socialization Problems – does not play well with other children; does not separate easily from parent; will not work in a group; is left out of peer activities.
______ 3. Speech/Language Problems – speech is unclear or garbled; difficulty expressing wants; incomplete language structure; often needs instructions repeated.
______ 4. Self-Help Problems – toileting difficulties; feeding or dressing problems.
______ 5. Attentional Problems – distracted easily; short attention span; darts from one task to another.
______ 6. Developmental Delays – does not appear to be learning at an average rate; delays in developmental milestones.
______ 7. Motor Problems – clumsy; has difficulty using tools. Hand/eye coordination problems; poor control of body movement.
______ 8. Hearing Problems – has trouble hearing; asks you to repeat or talk louder; favors one ear over the other, startles at sudden noise.
______ 9. Vision Problems – eyes turn in; eyes turn out; squints.
______ 10. Medical Health Related Problems – hospitalizations; serious illness; accidents.