KCSL appreciates your interest in our early childhood education services!

Please fill out the short form below to start the application process. After you submit, a KCSL staff member will contact you to finalize your application

Applicant Child's Last Name (as it appears on the birth certificate)

Applicant Child's First Name

Applicant Child's Date of Birth

Primary Guardian Last Name

Primary Guardian First Name

Primary Guardian Email Address

Primary Guardian Phone Number

Does the applicant have an Individualized Family Service Plan (IFSP)?

Does the applicant have Individualized Education Plan (IEP)?

Does anyone in your family receive Supplemental Security Income (SSI)?

Does your family receive Temporary Assistance for needy families (TANF)?

Does your family receive food stamp benefits?


Primary Address

Mailing Address (if different)

Address Line 1:

Address Line 2:

City:

State:

Zip:

Address Line 1:

Address Line 2:

City:

State:

Zip:




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