2021-2022 EUP Early Learning Collaborative Enrollment Application
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Enrollment Application
Filling out this application does not placement in a program. The agencies involved will determine what program your child may be eligible for and will send your paperwork to the appropriate program. Please fill out all information accurately, as any inaccurate information may hinder the application process.
1.
School Year Applying For:
2.
Applying Child's Last Name:
*
3.
Applying Child's Middle Initial:
*
4.
Applying Child's First Name:
*
5.
Applying Child's Gender:
*
Applying Child's Gender:
*
Female
Male
6.
Applying Child's Date of Birth:
*
mm/dd/yyyy
7.
Applying Child's Place of Birth (City, State):
*
8.
Applying Child's Country of Birth:
*
9.
Applying Child's Race/Ethnicity (check all that apply):
*
Select at least 1 and no more than 7.
Asian
Black
Hispanic
Native American
Pacific Islander
White
Other, please specify:
10.
Family Language:
*
English
Spanish
Other, please specify:
11.
Do you require an interpreter?:
*
Do you require an interpreter?:
*
Yes
No
12.
Resident School District:
*
Resident School District:
*
Bois Blanc
Brimley
DeTour
Engadine
Les Cheneaux
Mackinac Island
Moran
Pickford
Rudyard
Sault Ste. Marie
St. Ignace
Tahquamenon
Whitefish
Other, please specify:
13.
Home Street Address:
*
14.
City:
*
15.
ZIP Code
*
16.
County:
*
--Please Select--
Chippewa
Luce
Mackinac
17.
Mailing Address (if different than Home Address):
Street:
City:
Zip Code:
County:
18.
Phone(s):
*
Phone Number(s)
Home:
Cell:
Work:
Message:
19.
May we text you at the phone numbers listed?
May we text you at the phone numbers listed?
Yes
No
20.
Session Preference:
*
(Note: We cannot guarantee the session you choose, but we will do our best.)
Session Preference:
*
(Note: We cannot guarantee the session you choose, but we will do our best.)
AM
PM
All Day
Any