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Round 2 SchoolChoice Form: 2016-17 School Year
Office of Choice and Enrollment Services 720-423-3493 http://schoolchoice.dpsk12.org
TIPS ON COMPLETING THE SCHOOLCHOICE PROCESS SUCCESSFULLY 1. Learn about DPS schools and programs. Visit http://schoolchoice.dpsk12.org/how-to-choose-a-school/ to locate resources available to
help you find schools that offer the best fit for your student. Your student will be expected to attend their assigned school through the entire school year.
2. Visit your top choice schools. Contact the schools directly to find out about tours, open houses, and other opportunities to get to know that school.
3. Complete the Round 2 SchoolChoice Form and gather all required documentation. Use the Round 2 checklist below as a reference. Take your time.
4. Round 2 SchoolChoice forms are processed on a first-come, first-served basis. There is no lottery involved. If the school has available space for the 2016-17 school year at the time you submit your form, your student will be approved to enroll next year. If a waitlist exists, the student will be added to the end of the waitlist.
5. Turn in your Round 2 SchoolChoice Form and required documentation to your most-preferred school
ECE-3 and ECE-4: March 21, 2016 through April 14, 2017
Grades Kindergarten-12th: March 21, 2016 through Aug. 31, 2016
SchoolChoice Forms cannot be submitted by mail, e-mail, or fax.
REQUIRED DOCUMENTATION CHECKLIST Submit the documents indicated for your student’s grade level in order for Denver Public Schools to process your SchoolChoice Form. Incomplete forms will not be processed. Note: If a Round 1 form was submitted, you do not need to re-submit the information below.
Grade Level in 2016-17
New to DPS
(all grades)
ECE-3 (must be 3 by
Oct. 1, 2016)
ECE-4 (must be 4 by
Oct. 1, 2016)
Kindergarten (must be 5 by
Oct. 1, 2016) 1st – 12th
SchoolChoice Form Must be completed and signed by parent/guardian
X X X X X
Proof of Age Birth certificate; Baptismal record; Hospital record showing official signature; Passport; or I-94
X X X
Proof of Address Current utility bill with service address; Valid rental/lease agreement; Warranty deed; Bill of sale; Current mortgage statement; Property tax notice; or Signed contract stating your name, closing date and property address
X X X
Tuition Form (included) ECE and K
only X X X
Proof of Income 30 consecutive days of paycheck stubs; 2015 tax return; or Letter from employer on company letterhead that states hours worked and pay rate
AND Proof of any non-work income (TANF, food stamps, child support, etc.)
If the above are unavailable, an Income Affidavit may be submitted and is available at elementary schools and online.
ECE-4 only X
Denver Preschool Program (DPP) Application (included) ECE-4 only X
Home Language Questionnaire X X
Round 2 SchoolChoice Form: 2016-17 School Year ECE-3 and ECE-4: March 21, 2016 through April 14, 2017
Grades Kindergarten-12th: March 21, 2016 through Aug. 31, 2016
Office of Choice and Enrollment Services 720-423-3493 http://schoolchoice.dpsk12.org
SCHOOL USE ONLY
ACCEPT WAITLIST FULL-DAY HALF-DAY
Is the applicant qualified or applying for any of the following (check all that apply): Student has IEP Retained (repeating grade) ELA-E ELA-S
Form taken by (print name): ____________________________________________________ School #______________ Copy given to parent/guardian
Date received: ______/______/2016 Time received: _____:_____ am/pm Date Scanned to OCES: ______/______/2016 Address verified in IC
STUDENT INFORMATION Birth certificate and proof of address must accompany this form. Student’s NameMale
Last First Middle Name Female
Student’s Primary Home Address:
Street Apt # City State Zip
Birthdate: (mm/dd/yyyy) Current Age: Current Grade:
/ /
Grade Applying for in 16-17 (please check one box):
ECE-3 ECE-4 Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
ETHNICITY/RACE This information is required by federal law. Failure to answer questions will result in use of prior racial/ethnic data or an observer identifying for you.
Is your student Hispanic or Latino? Yes No
Race (select all that apply): American Indian or Alaskan Native Asian White
Native Hawaiian or Pacific Islander Black or African American
PREVIOUS SCHOOL INFORMATION Has the student previously attended a DPS school? Yes No
DPS School: _____________________________________________ Grade: __________ School Year: ___________
Where is student currently enrolled? Non-DPS School: Grade: City, State:
FREE AND REDUCED LUNCH I currently participate in, or am eligible to participate in, the Free and Reduced Lunch Program. By checking this box, you consent to the verification of your status as FRL eligible by Choice and Enrollment Services staff. No specific information from your FRL application will be obtained beyond eligibility status, and the information will not be retained. For information about the Free and Reduced Lunch Program, or to determine if you qualify, please visit: http://bit.ly/FRLapplication
DPS Student ID #:
PARENT/GUARDIAN CONTACT INFORMATION #1 Parent/Guardian’s Name Relationship to Student
Primary Contact Phone Number: Home Cell Work E-mail
Alternate Contact Phone: Home Cell Work
Parent/Guardian’s home address, if different than Student’s home address
Street Apt # City State Zip
In case of an emergency, contact the person above 1st 2nd
#2 Parent/Guardian’s Name Relationship to Student
Primary Contact Phone Number: Home Cell Work E-mail
Alternate Contact Phone: Home Cell Work
Parent/Guardian’s home address, if different than Student’s home address
Street Apt # City State Zip
In case of an emergency, contact the person above 1st 2nd
Round 2 SchoolChoice Form: ECE-4 (must be 4 years old by Oct. 1, 2016) 2016-17 School Year
Office of Choice and Enrollment Services 720-423-3493 http://schoolchoice.dpsk12.org
209 Beach Court - ECE 4 full day 206 Ashley - ECE 4 full day 181 Academy 360 - ECE 4 full day
209 Beach Court - ECE 4 half day 214 Bromwell - ECE 4 full day 292 Amesse - ECE 4 full day
215 Brown International - ECE 4 full day 217 Carson - ECE 4 full day 166 DCIS at Ford - ECE 4 full day
216 Bryant-Webster - ECE 4 half day 188 Cole Arts & Science - ECE 4 full day 179 Escalante Biggs - ECE 4 full day
297 Centennial - ECE 4 full day 222 Columbine - ECE 4 full day 179 Escalante Biggs - ECE 4 half day
218 Cheltenham - ECE 4 full day 177 Denver Green School - ECE 4 full day 197 Farrell B. Howell - ECE 4 full day
219 Colfax - ECE 4 full day 259 Dora Moore - ECE 4 full day 195 Florida Pitt Waller - ECE 4 full day
221 Columbian - ECE 4 full day 241 Garden Place - ECE 4 full day 195 Florida Pitt Waller - ECE 4 half day
224 Cowell - ECE 4 full day 242 Gilpin - ECE 4 full day 308 FNE ECE Center - ECE 4 full day
159 DCIS at Fairmont - ECE 4 full day 251 Hallett - ECE 4 full day 282 Green Valley - ECE 4 half day
228 Eagleton - ECE 4 half day 248 Harrington - ECE 4 full day 183 Highline Academy NE - ECE 4 full day
230 Edison - ECE 4 full day 170 High Tech Elementary - ECE 4 half day 236 Marrama - ECE 4 half day
238 Fairview - ECE4 full day 301 Isabella Bird Community School - ECE 4 full day 290 Maxwell - ECE 4 full day
172 Greenlee - ECE 4 full day 301 Isabella Bird Community School - ECE 4 half day 299 McGlone - ECE 4 full day
201 Sandoval - ECE 4 full day 210 Lowry - ECE 4 full day 150 Oakland - ECE 4 full day
189 Trevista - ECE 4 full day 254 McMeen - ECE 4 full day
205 Valdez - ECE 4 full day 257 Montclair - ECE 4 full day
257 Montclair - ECE 4 half day
262 Palmer - ECE 4 full day
207 Barnum - ECE 4 full day 263 Park Hill - ECE 4 half day 213 Bradley International - ECE 4 full day
220 College View - ECE 4 full day 190 Place Bridge - ECE 4 full day 231 Ellis - ECE 4 full day
226 Denison Montessori - ECE 4 full day 192 REACH Charter School - ECE 4 full day 294 Holm - ECE 4 full day
227 Doull - ECE 4 full day 163 Rocky Mountain Prep: Creekside - ECE 4 full day 162 Joe Shoemaker - ECE 4 full day
240 Force - ECE 4 full day 275 Smith - ECE 4 full day 252 Lincoln Montessori - ECE 4 full day
240 Force - ECE 4 half day 276 Steck - ECE 4 full day 264 McKinley-Thatcher - ECE 4 full day
243 Godsman - ECE 4 full day 277 Stedman - ECE 4 full day 296 Samuels - ECE 4 full day
244 Goldrick - ECE 4 full day 277 Stedman - ECE 4 half day 298 Southmoor - ECE 4 half day
235 Grant Ranch - ECE 4 full day 280 Swansea - ECE 4 full day 178 Stephen Knight Center - ECE 4 full day
246 Gust - ECE 4 full day 174 Swigert - ECE 4 full day 178 Stephen Knight Center - ECE 4 half day
249 Johnson - ECE 4 full day 281 Teller - ECE 4 full day
295 Kaiser - ECE 4 full day 253 Westerly Creek - ECE 4 full day
250 Knapp - ECE 4 full day 289 Whittier - ECE 4 full day
260 Munroe - ECE 4 full day 194 William Roberts - ECE 4 full day
261 Newlon - ECE 4 full day 194 William Roberts - ECE 4 half day
158 Pascual Le Doux Center - ECE 4 full day
184 Rocky Mountain Prep: SW - ECE 4 full day
269 Sabin - ECE 4 half day
271 Schmitt - ECE 4 full day
283 Traylor - ECE 4 full day
285 Valverde - ECE 4 full day
FAR NORTHEAST DENVER SCHOOLS
SOUTHEAST DENVER SCHOOLSSOUTHWEST DENVER SCHOOLS
NORTHWEST DENVER SCHOOLS NEAR NORTHEAST DENVER SCHOOLS
ECE-4 PROGRAM PREFERENCE The program and space availability may be subject to change.
Please fill in the box with the school/program that you would like your child to attend.
Name of School/Program: _________________________________________________________________________________________________
I prefer: ❏ Full Day Class ❏ Half Day Class
*Please note that requests for AM/PM programs can only be accommodated per school’s availability.
I understand that by signing this Round 2 SchoolChoice form, I agree to follow the SchoolChoice
process; have read and agree to all information listed on this form; all information submitted
on this form is accurate to the best of my knowledge; and I am accepting the resulting
SchoolChoice school assignment for my child.
I understand DPS reserves the right to make attempts to verify information submitted, and my
child’s school of assignment will not be guaranteed if content cannot be confirmed as accurate.
Parent/Guardian Name (please print): _____________________________________________________
Parent/Guardian Signature: _____________________________________________________________ Date: __________________
Student Name:
DPS Student ID #:
TOMORROW STARTS NOWApproved by voters in 2006 for an initial period of 10 years, the Denver Preschool Program (DPP) makes high quality preschool possible for all Denver 4-year-olds regardless of income or neighborhood. To ensure preschool programs are high quality, DPP invests more than $1 million annually in over 250 individual preschools across the city, providing them the help they need to deliver high quality education.
To qualify you must live in the City and County of Denver and your child must be in their last year of preschool before kindergarten at a participating DPP program. The amount of support a family receives depends on family size and income, the quality of the preschool chosen, and the length of day and number of days per week a child attends preschool. Only children attending one of DPP’s contracted preschools can receive tuition support. If your preschool isn’t a DPP preschool partner, please encourage them to contact us to learn how to sign up. Once your preschool is a DPP preschool partner and your application is approved, you can begin to receive tuition support. For an estimated tuition credit, please visit dpp.org/calculator.
2016-2017SCHOOL YEAR
DENVER PRESCHOOL PROGRAM APPLICATION
Child’s name ________________________________________________________________________________________________________________________
dpp.org101
Required DocumentsPlease provide the following required documentation for this application. Missing documents may delay the processing of your application.
VERIFICATION OF CHILD’S AGE A copy of the child’s Birth Certifi cate, baptismal record, or hospital record showing child’s birth.
VERIFICATION OF CURRENT ADDRESSA copy of current lease, proof of home ownership, or utility bill (with service or premise address listed) such as your bill for gas, electric, water or cable.
VERIFICATION OF ONE MONTH’S INCOME Most current check stubs (if paid more than once a month, include all stubs for month), wage statement, tax return or other work documents for each parent/guardian’s income. If none of these documents are available, you may provide an income aff idavit by contacting 303.595.4DPP(4377).
DPP does not discriminate against any person on the basis of race, color, religion, national origin, gender, age (except as to the age of the children qualifying for tuition credits), military status, sexual orientation, gender variance, marital status, or physical or mental disability.
dpp.org102
Section I. Family Information
DPP partners with two consultants, APA, Inc. and the Institute at Clayton Early Learning, to conduct an in-depth research study of DPP to measure the difference preschool makes for children and their families. • Any family that participates in DPP can volunteer to be a part of the research study. • If you are selected for the research study, your child will be assessed by a trained early childhood professional
using a 20-30 minute standardized test at preschool in the fall and spring. • You can receive your child’s assessment results.• You will also be asked to complete a short survey in the spring. • Analysis will be of group data, and no one will be identified individually. • You will be compensated for your participation.
Are you willing to have someone contact you about the research study? Yes No
Section II. Research Study Participation
Child’s Race/Ethnicity
American Indian/Alaskan Native Black (Not of Hispanic Origin) Asian or Pacific Islander Hispanic White (Not of Hispanic Origin) Other—please specify:
______________________________________ ______________________________________
Child’s Primary Language
EnglishSpanishVietnameseArabicRussianOther—please specify:
_____________________________________ _____________________________________
Language Spoken at Home
EnglishSpanishVietnameseArabicRussianOther—please specify:
_____________________________________ _____________________________________
Section III. Preschool Information
The DPP preschool you have chosen for your child for the 2016-2017 school year
Name of Preschool Program ____________________________________________________________________________________________________________________ Street Address/Apt ________________________________________________________________________________________________________________________________ City, State, Zip ______________________________________________________________________________________________________________________________________
Part-Day (at least 5 hours per week AND at least 2.5 hours per day on the days of attendance)
Full-Day (at least 25 hours per week AND at least 5 hours per day on the days of attendance)
dpp.org103
Household Gross Monthly Income Please fill in the chart below with work and non-work income information for all parents/guardians in your household and attach documentation for all income. Accepted documents are listed on the front of this application. Information needs to be in monthly totals.• Work income includes wages/earnings/tips or income from self employment. • If self-employed or do not have proof of income, you may complete an income affidavit by contacting 303.595.4DPP(4377). • Non-work income includes TANF, child support/alimony, trust income, etc.
(List all non-work income below)
Name of Parent/GuardianLast Name, First Name
Monthly Work IncomeMost Recent Gross Monthly Income/Salary/Wages/Tips
Monthly Non-Work Income TANF, Child Support, Trust Income, etc.
Monthly Total Income All Work and Non-Work Income
TOTAL (Before Taxes): TOTAL: TOTAL:
Section IV. Income Information
Are you applying for or participating in any of the following programs?Colorado Child Care Assistance Program (CCAP)Head StartColorado Preschool Program (CPP)
Circle total number of people in household (including yourself and your child)
2 3 4 5 6 7 8 9
If you do not wish to disclose your income please check here and skip to next page. (By doing this you are choosing the minimum level of financial assistance.)
I would like to provide my household gross monthly income and have included verification documents. (Information below required.)
All parents/guardians need to read and sign below:
I declare that the information reported is true, correct, and complete. I agree to provide, if requested, any necessary documentation to support the information reported. I authorize the Denver Preschool Program (DPP) to release any information in the Application to DPP partner agencies including the Colorado Child Care Assistance Program, Denver Department of Human Services, Colorado Preschool Program (CPP), Head Start, and Denver Public Schools for the purpose of record keeping and audits. I release DPP from any and all liability arising from the release, review or copying of such information. DPP may require other information in the event of an audit.
This Agreement is entered into by the DPP and the following-named parent or guardian (”Parent”) in accordance with the application filled out by the parent/guardian on ___________/___________/___________(Date). The following are the basic terms of the Agreement:
• Parent agrees to participate and to allow their DPP-enrolled child to participate in DPP evaluation. The program evaluation will provide information on how the program is working through interviews, observations and small groups. The information will only be shared with DPP consultants unless DPP and the Parent give approval for sharing information with others.
• We will never sell or rent your personal information to third parties for their use without your consent. We may however use your personal information for Denver Preschool Program purposes.
• Parent understands the importance of the child being in attendance in preschool whenever the preschool is in session and agrees to notify the provider if the child is going to be absent and the reason for the absence when appropriate.
• It is the responsibility of the Parent to comply with the rules and regulations of the provider and DPP, including those relating to absences.
• Parent understands that the DPP can terminate the tuition credit if the Parent or child fails to comply with these rules and regulations.
• Parent understands that the tuition credit is determined in accordance with a DPP-approved formula that takes into account parental/guardian income, family size, and the quality rating of the provider - and is dependent upon the annual funding to DPP by the City and County of Denver.
If Parent has questions about the tuition credit or other issues related to this agreement, Parent should contact DPP at 303.595.4DPP(4377) or visit dpp.org.
Parent/Guardian’s Printed Name Preparer’s Printed Name (If different than parent or guardian)
Signature of Parent/Guardian Preparer’s Signature (If different than parent or guardian)
Date (mm/dd/yyyy) Date (mm/dd/yyyy)
Section VI. Parent Agreement & Release of Information
04
Section V. Tell Us How You Heard About Us
Community fair or festivalDPP brochureDPP postcardDPP Preschool ShowcaseDPP community presentation
From a friend or family member From staff at your child’s preschoolOnline adOnline searchPrint ad
RadioSign or billboardSocial MediaTVOther: __________________________
How did you first hear about DPP? (required)
Did you use DPP resources (Preschool Showcase, DPP’s online Find a Preschool tool, DPP call center) in helping to find and choose your child’s preschool?
Yes No
Round 2 SchoolChoice Form: ECE-4 (must be 4 years old by Oct. 1, 2016) 2016-17 School Year
Office of Choice and Enrollment Services 720-423-3493 http://schoolchoice.dpsk12.org
4-YEAR OLD EARLY CHILDHOOD EDUCATION GUIDELINES & RATES
A B C D E F
& opt out Non-Denver
Resident
MONTHLY GROSS INCOME
HOUSEHOLD SIZE Up to From Up to From Up to From Up to From Up to Greater than
2 $2,425 $2,426 $3,186 $3,187 $3,983 $3,984 $4,514 $4,515 $9,425 $9,307
3 $3,051 $3,052 $4,018 $4,019 $5,023 $5,024 $5,692 $5,693 $11,887 $11,709
4 $3,677 $3,678 $4,850 $4,851 $6,063 $6,064 $6,871 $6,872 $14,348 $14,111
5 $4,303 $4,304 $5,682 $5,683 $7,103 $7,104 $8,050 $8,051 $16,513 $16,513
6 $4,929 $4,930 $6,514 $6,515 $8,143 $8,144 $9,228 $9,229 $19,271 $18,916
7 $5,555 $5,556 $7,346 $7,347 $9,183 $9,184 $10,407 $10,408 $21,732 $21,318
8 $6,181 $6,182 $8,178 $8,179 $10,223 $10,224 $11,586 $11,587 $24,193 $23,720
PROGRAM TUITION PER MONTH
ECE-4 HALF DAY Tuition-
Free $30 $114 $206 $324 $412 $448
ECE-4 FULL DAY Tuition-
Free $61 $228 $413 $648 $825 $896
Non-Refundable Registration Fee (included in first invoice)
$0 $25 $35 $45 $50 $50 $60
GENERAL SCHOOLCHOICE PARENT/GUARDIAN AGREEMENT Guarantees: ECE-3: not guaranteed due to limited state funding ECE-4: not guaranteed due to limited state funding Kindergarten (full-day): Guaranteed enrollment at neighborhood boundary school if I have not “choiced out” Grades 1-12: Guaranteed enrollment at neighborhood boundary school if I have not “choiced out”
I understand that my student is guaranteed enrollment (full day for Kindergarten) at our neighborhood school if I have not “choiced out” of that school. However, if I complete this form and am enrolled in a school other than my neighborhood boundary school, I am “choicing out” and giving up my students guaranteed seat at my neighborhood boundary school, including the seat they may have received during Round 1.
I understand it is my responsibility to know if my address resides in the DPS boundaries. I can confirm this by going to: http://maps.dpsk12.org/ Note: Some addresses in Denver do not coincide with the Denver Public Schools District 1.
I understand that if I “choice out” of my neighborhood school, transportation is not guaranteed. Transportation is not provided for students applying for ECE.
I understand that it is my responsibility to complete any required additional steps necessary to qualify for a program to which I would like my student assigned, such as auditions, interviews, testing, etc.
I understand that if my student is not qualified or the appropriate age for a program he/she will not be enrolled or waitlisted in that program, even if I have listed that school/program on this form.
I understand that there is no guarantee that my student will be placed in his/her most-preferred school. Round 2 SchoolChoice is based on a first come, first served basis.
I understand that my student will not receive multiple school assignments. SchoolChoice is designed to assign only one most-preferred school to ensure equitable access for all families.
I understand that my student will be waitlisted at any schools/programs where there are no current seats available.
I understand that once enrolled in a school, it is my responsibility to abide by any school-specific requirements.
I understand that if my address has changed and does not match the primary address on file with Denver Public Schools, it is my responsibility to update my address with the office staff at my student’s current school by providing new address documentation. If I do not update my address, my student’s SchoolChoice Form may not be processed.
I understand that the primary home address listed on this form is where my student currently resides. Address falsification may be subject to investigation, which may result in a withdrawal from the assigned school.
ECE/Kinder applicants only: I certify that all income information provided is true and correct and that all income is reported. I understand this information is being given for the receipt of Federal and State funds and that school officials may verify the information on the application and further agree to release my student’s Free and Reduced Lunch status. I understand that if I knowingly give false information my student(s) may lose the benefit garnered and that I may be prosecuted. I understand that I am responsible for the full amount of tuition billed to me and agree to pay the monthly fee (as calculated by the Office of Choice and Enrollment Services and which is based on my monthly income) once the school year begins.
Families must live in the Denver Public Schools district to be eligible for tuition assistance. Non-Denver residents must pay full tuition. You may be chosen to participate in a
yearly audit and, if chosen, will need to provide adequate documentation of the income stated below. If you are unable to provide the documents supporting the income
stated, your tuition level may be readjusted to a full-pay tuition amount. Denver Public Schools’ cost to provide preschool for 4-year-olds is $896 per month per child for full-
day, and $448 per month per child for half-day. DPS is able to provide tuition rates below cost because of additional funding sources such as Colorado Preschool Program,
HeadStart, and others. For more information regarding how tuition rates are determined, please contact the Office of Choice and Enrollment Services. Your tuition rate will
be confirmed in March 2016 via mail. To maximize the amount of tuition assistance you are eligible to receive, you MUST submit all required documentation. Below is the
tuition rate you can anticipate paying each month.
Example: You have a family of four and your household gross monthly income (before taxes) is $3,679, which is located in column B. You are enrolling your 4-year-old child into a half-day preschool program. Your estimated monthly tuition rate is $30.
