Select State
Select State
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District Of Columbia
  • Florida
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  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
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  • Ohio
  • Oklahoma
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  • Puerto Rico
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  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgin Islands
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Year Entering Kindergarten
None
  • 2018
  • 2019
  • 2020
  • 2021
  • 2022

Child’s Birth Date

Month
Month
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
Day
Day
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8
  • 9
  • 10
  • 11
  • 12
  • 13
  • 14
  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
Year
Year
  • 2017
  • 2016
  • 2015
  • 2014
  • 2013
  • 2012
Do you have a computer?
None
  • Yes
  • No
Do you have internet?
NONE
  • Yes
  • No
Primary Language?
None
  • English
  • Spanish
How did you hear about us?
None
  • Former Participant
  • Word of Mouth (friend or relative)
  • Head Start
  • Advertisement
  • Schools
  • District or Pilot Liaison
  • Church
  • Community Organizations and Services
  • Other

Optional Message