UNM Taos Kid S Campus Center for Early Learning

NM PreK

Number ______

UNM Taos Kid’s Campus Center for Early Learning

NM PreK Application 2017-2018

Please return completed form on or before March 31, 2017 to:

UNM Taos Kid’s Campus

1157 County Rd 110

Ranchos de Taos, NM 87557

______

The lottery drawing will be held on April 1, 2017. All applications returned after April 1, 2017 will be added to the end of the waiting list established by the lottery drawing. Completion of this form does not prevent or guarantee a student’s enrollment in UNM Taos Kid’s Campus Pre K Program. All students must be 4 on or before September 1, 2017. For more information, please call (575) 737-6295 or (575) 737-6255.

Student Name:______Male______Female______

Date of Birth: ______Age: ______

Has your child previously attended an early childhood program? ______yes ______no

Parent/Guardian Name(s): ______

Home Phone: ______Work Phone: ______

Cell: ______Email:______

By signing below, I certify that I am the parent or legal guardian of the student named in the application and that all information provided is true and correct to the best of my knowledge.

Parent/Guardian Signature:

______Date:______