PreK Application for Lottery Application for UWELC at Kaune United Way Early Learning Center at Kaune Child's Name* First Last Child's Date of Birth*Gender*Primary language spoken at home:*Additional languages spoken in the home:Home Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country I am applying for (Please check all that apply):* Full day/ Full year - Monday - Friday 7:30 a.m. until 5:30 p.m. (Begins August 2019) PreK only Monday - Thursday 8:30 a.m. until 2:30 p.m. and Friday 8:30 a.m. until 12:30 p.m. (August through May) June and July 2019 - Full Day 7:30 a.m. until 5:30 p.m. June and July 2019 - Partial Day - Monday - Thursday 8:30 a.m. until 2:30 p.m. and Friday 8:30 a.m. until 12:30 p.m. How will you be paying for your child's care? (PreK is free to all participants)* CYFD Childcare Assistance Self Pay Partial Scholarship I need more information about options Parent/ Guardian Name* First Last Parent/ Guardian Date of Birth* Parent/ Guardian Phone*Parent/ Guardian Email* Parent/ Guardian Name First Last Parent/ Guardian Date of Birth Parent/ Guardian PhoneParent/ Guardian Email Alternate Contact Name* First Last Phone*Relationship to the Child*Have you had any other children attend PreK through United Way of Santa Fe County?* Yes No If yes, what was the name of the participant?When did this participant begin the program? When did this participant end the program?Has your family participated in First Born® or Family, Friends & Neighbors programs offered by United Way of Santa Fe County?* Yes No If yes, what was the name of the participant?When did this participant begin the program?When did this participant end the program?At age 3, did your child attend another Early Childhood Program?* Yes No If yes, where and for how long?Does your child have an Individual Education Plan (IEP) or Individualized Family Service Plan (IFSP)?* Yes No If yes, what services/accomodations does your child receive?