what should champlain valley school district (cvsd...
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What Should Champlain Valley School District (CVSD) Families Know
About Universal/Publicly Funded Prekindergarten (PreK)?
Publicly funded prekindergarten is defined as 10 hours per week, 35 weeks per
year (“school year”). PreK enrollment is a family choice– voluntary. Not mandatory! Children must be at least 3 years old by September 1, 2020. According to the VT Agency of Education, children who are 3, 4 and 5 years old
and not enrolled in kindergarten are eligible to receive publicly funded PreK at this time.
Publicly funded PreK services can be in schools and qualified community-based programs (homes and centers). This link will bring you to a searchable data base of qualified prekindergarten providers in VT (scroll to “prequalified providers list”). https://education.vermont.gov/student-support/early-education/universal-prekindergarten-act-166/families-of-prekindergarten-students
The state tuition rate paid to community-based private PreK providers on behalf of children attending PreK during the 2020-21 school year is $3,445.
If want your child to attend a program offered in a CVSD school by the school district, contact your local school directly for information about enrollment.
If your child is going to attend a qualified PreK program in the community, you will have to enroll both with the community PreK program/provider and with your school district, this ensures that tuition funding for your child is sent to the program. In many cases the community-based program/provider can assist you in enrolling in publicly funded PreK with CVSD.
CVSD will provide you with an email confirmation when they have all the required paperwork and documentation needed to confirm your child’s prekindergarten funding. The CVSD PreK enrollment contact is [email protected].
Plan ahead! Many community and school based programs begin PreK enrollment in winter/early spring. Contact your school and community programs to find out about enrollment opportunities and enrollment dates.
If you have general questions about publicly funded PreK contact Shelley Henson,
CVSD Early Education Director at [email protected], 985-1936.
VT Pre-qualified Programs for Universal Prekindergarten (PreK) Funding Below is a partial list of programs currently approved by the VT Agency of Education for publicly
funded PreK: Please note you may search a data base with all of the pre-qualified prekindergarten
programs by using the link below.
http://education.vermont.gov/student-support/early-education/prekindergarten
Adventures in Early Learning - Shelburne,
985-9025
Annette’s Preschool – Hinesburg, 482-2525
Ascension Childcare, Inc. – Shelburne, 658-
0212
Bellwether – Williston, 863-4839
Burlington Children’s Space – Burlington,
658-1500
Champlain Islands Parent Child Center –
South Hero, 372-4704
Charlotte Children’s Center – Charlotte, 425-
3328
Children Unlimited - Williston, 878-5899
Children’s Preschool & Enrichment Center –
Essex Jct., 878-1060
The Children’s School – So. Burlington, 862-
2772
Davis Studio Preschool - So Burlington 425-
2700
Discovery Preschool – So. Burlington, 860-
4370
Donna Leicht (Donna’s Labor of Love) –
Burlington, 660-9621
Early Learning Center at St. Michael’s
College– Colchester – 654-2650
EJ’s Kids Klub – Williston, 860-1151
EJRP Preschool – Essex Jct., 878-1375
Green Mountain Montessori School – Essex
Jct., 879-9114
Heartworks - Burlington, Shelburne,
Williston, 985-2153
Hinesburg Nursery School – Hinesburg,
482-3827
Home-based Early Ed.: (Elsa Bosma,
Heather Friedrichson, Sheila Quenneville,
April Ploof, Colleen Christman
Kids & Fitness - S. Burlington, 658-0080 -
Williston, 864-5351 – Essex, 879-7734
Kid Logic Learning – So. Burlington, 660-
3600
Kinderstart – Williston, 876-7056
Lake Champlain Waldorf School -
Shelburne, 985-2834
Little One’s University – Essex Jct., 872-
7444
Nadeau’s Playschool – Williston, 658-9800
Pine Forest Children’s Center – Burlington,
651-9455
Robin’s Nest Children’s Center – Burlington,
864-8191
Saxon Hill Preschool – Jericho, 899-3832
The Schoolhouse - S. Burlington, 658-4164
Shelburne Nursery School – Shelburne,
985-3993
STEAMworks – Essex Jct., 985-2153
Stepping Stones - Burlington, 860-1915
Stonewood School North – Shelburne, 985-
8118
Trinity Children’s Center – Burlington, 656-
5010
UVM Children’s Center – Burlington, 656-
4050
Williston Enrichment Center - Williston, 846-
9402
YMCA – Greater Burlington - Burlington,
862-9622
YMCA – UVMMC – Winooski, 338-9208
CVSD School District Programs-
Williston, Shelburne, Hinesburg/Charlotte
(contact your local elementary school
directly for information about school-
based pre-kindergarten enrollment
2020-2021 Champlain Valley School District (CVSD)
Publicly Funded Prekindergarten (PreK) Program Application
Public education funding is to support 10 hours of PreK per week (35 weeks beginning 9/7/20). Your child must
enroll in a program for a minimum of 10 hours a week to receive funds. *Age-eligible children may enroll during the
school year, however, tuition will be prorated. The PreK program your child attends may not charge you for the 10
hours per week of PreK paid for by your school district. Please contact the PreK program for more information about
their fees for any additional time your child attends the program.
For enrollment in your local school-based prekindergarten program please contact your local elementary
school directly for information about PreK enrollment.
Child’s Name:_______________________________________________________________________________________________________________________
Date of Birth:______________________(*child must be 3, 4 or 5 years old and not attending Kindergarten on or before of
September 1, 2020 to qualify for funding)
Parent/Guardian’s Name(s): ______________________________________________________________________________________________________
Child’s Address: ____________________________________________________________________________________________________________________
Telephone: Parent/Guardian 1 ___________________________________ Parent/Guardian 2________________________________________
Email 1:_________________________________________________________Email 2:____________________________________________________________
Did this child receive publicly funded PreK from CVSD during the 2019-20 school year? Yes No
Town your child resides in (circle one): Charlotte Hinesburg Shelburne St. George Williston
Is your child enrolled in PreK for fall 2020? Yes Not yet
Name of PreK Program Your Child Will Attend (2020-21 school year)_____________________________________________________
Program Location (Town/City) ________________________________________________________________________________________________
Enrollment Start Date: 9/7/20 or Other (specify)____________________________
Program Contact Name: _________________________________________________Email or Phone number______________________________
Please return this application and the required school district registration documents to: Wendy Clark,
Champlain Valley School District, 5420 Shelburne Road, Suite 300, Shelburne, VT 05482.
For questions about PreK registration contact Wendy Clark at [email protected]
For general questions about universal PreK (Act 166) contact Shelley Henson at [email protected]
(Parent Signature) __________________________________________________________________________(Date)______________________________________
*By signing this document I give consent for CVSD to communicate with my child’s PreK provider about my child for the
purposes of providing publicly funded PreK/facilitating kindergarten transitions (including obtaining child records such as
attendance and child assessment reports).
Student Registration Form
STUDENT INFORMATION
FULL NAME Last: First: Middle:
Gender: _____
Date of Birth:
Grade Level:
Last Grade Level Completed:
Instructional Plan (e.g. IEP, 504, EST)?
Race/ethnicity (check all that apply): □White □Asian □Black/African American
□American Indian or Alaskan □Native Hawaiian/Pacific Islander
□Other (please specify)_________________________________ □Hispanic/Latino
Languages other than English spoken in the home :
Place of Birth City / State:
Name of Last School Attended:
Address of Last School Attended:
City: State: ZIP Code:
THIS AREA FOR OFFICE USE ONLY
Date Completed: Teacher:
Start Date: House/Team:
PK Start Date: PK Org ID:
ID#: Notes:
5420 Shelburne Road, Suite 300, Shelburne, VT 05482
Telephone 802-383-1234 Fax 802-383-1242
STUDENT LIVES WITH: □ PARENT 1 (SPECIFY BELOW) □PARENT 2 (SPECIFY BELOW) □BOTH PARENT 1 AND PARENT 2 (SPECIFY BELOW) □OTHER (PLEASE SPECIFY)
__________________________________________________________
PARENT INFORMATION
Parent 1 Name:
Mailing address:
City: State: Zip Code:
Home phone: Work phone: Cell phone:
Email address:
Parent 1 has legal custody: □Yes □No* *If No, court order must be submitted to school
Parent 2 Name
Mailing Address (if different from student):
City: State Zip Code:
Home phone: Work phone: Cell phone:
Email address:
Parent 2 has legal custody: □Yes □No* *If No, court order must be submitted to school
Other Guardian Name:
Physical address (if different from student)
City: State: Zip Code:
Home phone: Work phone: Cell phone:
Email address:
Other Guardian has legal custody: □ Yes □No
EMERGENCY CONTACT INFORMATION
Name: Relationship to student:
Physical address:
City: State: ZIP Code:
Home phone: Work phone: Cell phone: SIBLING INFORMATION
Sibling 1 Name: Date of Birth:
Sibling 2 Name: Date of Birth:
Parent Signature: Date:
Proof of Residence
I affirm that _____________________________ is eligible to attend school in: student name
____Charlotte ____Hinesburg ____Shelburne ____Williston ____CVU
because his/her parent(s) or guardian(s) ____________________________________________ Parent or guardian name(s) ____ Have purchased a home within the town of ____________________, which is Name of CVSD town
occupied as their legal residence;
____ Have leased a home within the town of _____________________, which is Name of CVSD town occupied as their legal residence;
____ Are living with a resident from _____________________, which is Name of CVSD town occupied as their legal residence.
As proof of this residence, I have presented one of the following showing the physical address:
____ Purchase Agreement*
____ Warranty Deed*
____ Lease Agreement*
____ Voter Registration (copy of receipt or Town Clerk’s confirmation)*
____ Notarized letter from the school district resident with whom I am residing
accompanied by proof of their residency*
OR, TWO of the following:
____ Utility bill which shows the physical address of the residence*
____ Other (example: valid Vermont Driver’s License which shows the physical address
of the residence*
*Please black out or otherwise remove any information you choose to have remain private.
Item(s) presented for proof of residency must show the resident’s name and the 911 physical
address of the residence.
Signature: ____________________________________________Date: ____________________
Print Name: __________________________________________ Date: ____________________
I acknowledge that the above information has been presented showing a residence in
_________________________________ Name of CVSD town
Signature of School Official: ______________________________ Date: ___________________
˙ ˙ ˙ ˙
Vermont Agency of Education
Page 1 of 1 Primary Home Language Survey (Revised November, 2019)
Primary/Home Language Survey for All Kindergarten and Incoming Students
Instruction for schools in completing the survey: 1. Interview the parents/guardians of ALL new Kindergarten and incoming students in grades K-12
and record all information requested.2. Provide interpreting services whenever necessary.3. Please check to see that all questions on the form are answered.4. A copy of any survey with a language other than English should be referred to the EL Teacher for
further screening to determine if the student is an English Learner (EL).5. Surveys for students identified as ELs should be faxed (802-828-6433) or mailed to:
Jim McCobb, Title III/EL State Director, Vermont Agency of Education, 1 National Life Drive, Davis 5, Montpelier, VT 05620-2501.
6. Place the original survey form in the student’s permanent file.7. For questions contact Jim McCobb at [email protected] or via phone (802) 828-1533.
Student Information (Parents/Guardians should complete this section.)
First Name: Last Name: Date of Birth (Month/Day/Year)
Gender:
F M
Country of Birth: Date of Entry in U.S. (Month/Day/Year):
Date student first began Kindergarten (or higher grade) in any U.S. school (Month/Day/Year):
Questions for Parents/Guardians Response
What is the native language of each parent/guardian?
What language(s) are spoken in your home?
Which language did your child learn first?
Which language does your child use most frequently at home?
Which language do you most frequently speak to your child?
What other languages does your child know?
School Information (School Staff should complete this last section based on information gathered from parent/guardian.) What school will the student attend?
Beginning date in this school (Month/Day/Year):
What grade will the student enter? Person Conducting Survey:
2019 – 2020 Household Income Form
Vermont Agency of Education
Your school is participating in a Pre-Kindergarten education program, or may be Community Eligible or a
Provision 2 school where all students qualify for free meals. However, to determine eligibility to receive
additional benefits beyond free meals for your child/children in a PreK program, CEP or Provision 2
school, please complete the household income form. Return form to: Wendy Clark, Champlain Valley
School District, 5420 Shelburne Road, Suite 300, Shelburne, VT 05482.
1. In Section 1, check the box that shows the number of people in your household. Be sure to include
all children and adults, related and un-related, that live in a single dwelling and share income and
expenses.
2. In Section 2, check the box that shows the range of annual income for all people in your household.
Make sure to include all of the following income sources: work, welfare, child support, alimony,
pensions, retirement, Social Security, SSI, VA benefits, child income and/or all other income. The
amount should be before any deductions for taxes, insurance, medical expenses, child support, etc.
3. In Section 3, check the appropriate box if your household receives benefits from one of these
programs.
1. Total No. of
people in household
2. Select the appropriate range of combined annual income for all people in the household
(Include all income sources listed above before taxes.)
1 At or below - $16,237 Above $16,237 & at or below $23,107 Above $23,107
2 At or below - $21,983 Above $21,983 & at or below $31,284 Above $31,284
3 At or below - $27,729 Above $27,729 & at or below $39,461 Above $39,461
4 At or below - $33,475 Above $33,475 & at or below $47,638 Above $47,638
5 At or below - $39,221 Above $39,221 & at or below $55,815 Above $55,815
6 At or below - $44,967 Above $44,967 & at or below $63,992 Above $63,992
7 At or below - $50,713 Above $50,713 & at or below $72,169 Above $72,169
8 At or below - $56,459 Above $56,459 & at or below $80,346 Above $80,346
9 At or below - $62,205 Above $62,205 & at or below $88,523 Above $88,523
10 At or below - $67,951 Above $67,951 & at or below $96,700 Above $96,700
11 At or below - $73,697 Above $73,697 & at or below $104,877 Above $104,877
12 At or below - $79,443 Above $79,443 & at or below $113,054 Above $113,054
If household size is more than 12, list the household size and total annual
income below.
Size: _____ Income:
3. Indicate if your household receives assistance
from one of these programs: 3SquaresVT Reach-Up
4. List all students in the household. If any child you are reporting is in universal PreK; a foster child;
homeless, migrant, runaway; or attends Head Start, please check the appropriate box.
Student’s First Name Student’s Last Name
Grade
Level School Child Attends
Pu
bli
c o
r
Pri
vat
e
Un
iver
sal
Pre
K
Fo
ster
Ho
mel
ess,
Mig
ran
t,
Ru
naw
ay
Hea
d S
tart
Contact information and adult signature
“I certify (promise) that all information on this application is true and that all income is reported.”
_____________________________________________________________________________ Name of Adult Completing the Form (printed)
____________________________________________________________________________________
Signature Today’s Date
____________________________________________________________________________________
Street Address (if available), Apt # City State Zip Code
( )
Daytime Phone Email
(Optional) (Optional)
CHECKLIST
Have you included all your children as household members?
Are both the household size and total household income range boxes checked?
Have you signed the form?
DO NOT FILL OUT THIS PART. THIS IS FOR SCHOOL USE ONLY.
Economic Status: Meets the free guidelines _______
Meets the reduced guidelines _______
Income over the guidelines _______
I have reviewed the above and have concluded that it is properly and completely filled out to the best of my
knowledge.
Signature (of school or district staff):________________________________________________________
Print Name: ___________________________________________________________________________
Date: _____________________
Reminder: All costs associated with distributing, collecting, and reviewing these household income
forms must be paid for with funds outside of the nonprofit school food service account.