Thank you for your interest in our preschool program. Our program offers a sliding scales so that as many families in need of services can be supported.

Please answer the following prompts to the best of your ability.

Full Name *

Address *

City *

Email *

Postal code *

State *

Phone *

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the business.

Household Information:

Number of adults in the household *

Number of children and their ages *

Number of children you wish to enroll in our program this academic year *

Income Details:

Total annual household income as stated in most recent tax document *

Sources of income (e.g., employment, government assistance)

Upload the following documents such as recent tax returns to verify income. Pay stub will suffice IF no taxes were filed.

Upload document here *

Expenses:

Monthly expenses (e.g., rent/mortgage, utilities, groceries) *

Any outstanding debts or financial obligations *

Special Considerations:

Any other relevant information the family feels is important for you to consider when assessing their financial situation *

Authorization for Use of Information

I hereby authorize Q&A Preschools to use the information provided in this application for the sole purpose of determining eligibility for the sliding scale tuition rate. I understand that the information collected, including household income, expenses, and any supporting documentation, will be used strictly for this purpose.

I consent to Q&A Preschools verifying the accuracy of the information provided by conducting any necessary checks or inquiries. I understand that this information will be kept confidential and will only be accessed by authorized personnel involved in the tuition rate determination process.

I acknowledge that the accuracy of the information provided is my responsibility, and I agree to promptly inform Q&A Preschools of any changes to my financial circumstances that may affect my eligibility for the sliding scale tuition rate.

By signing below, I confirm that I have read and understand the terms of this authorization and give my consent for Q&A Preschools to use the provided information as described herein.

Your Signature *

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Date Signed *