Student Application Form

Monthly Income Fee Structure
Family Size	1 or 2	3	4	5	6	7	8 or more
Infant/Toddler Program	< $6,128	< $6,931	< $8,025	< $9,309	< $10,593	< $10,834	< $11,074
*Maximum* Monthly Fee	$72

Monthly Income Fee Structure
Family Size	1 or 2	3	4	5	6	7	8 or more
Preschool Program	< $7,209	< $8,154	< $9,441	< $10,952	< $12,462	< $12,745	< $13,029
*Maximum* Monthly Fee	$72

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Eligibility:	Need:
1. Protective Services	1. Protective Services
2. Current Aid Recipient	2. Employed/Seeking Employment
3. Income eligible (See table below)	3. Education/Training
4. Homeless	4. Seeking Permanent Housing
	5. Parent/Guardian Incapacitation

Student Application Form

Child's Information

Family Information

Information about the Second Parent

Child's Background

About You and All Five

2023-24 ALL FIVE PROGRAM FEE FORM

Monthly Income (before tax):

Please be sure to date and sign your application.