(ssp-00001a) Shining Stars Lottery Application

Lottery Application

Shining Stars PreSchool

2100 Lionel Street NE, Rio Rancho, NM 87144

505-892-7735

Principal: Kimberly Johns

Assistant Principal: Karla Zamora-Urban

Where all students SHINE!

Click to download Guidelines & Read Before completing application:Spanish and English

Please Submit ONLY one application per child. Duplicate applications will be removed.

Please double check childs date of birth as dates will be verified. Thank you.

Applications submitted before March 27, 2023 will not be eligible for next school year (2023-24).
Please note, if you have completed an application for the 2022-23 school year, you will need to submit an application for the 2023-24 school year (applications do not carry over from year to year).

Date received *

Child's name *

Date of Birth * 🛈 +

Gender *

Child's age * 🛈

Address *

City *

State * 🛈

Zip *

1st Parent/Guardian's Full Name *

Parent/Guardian's Email *

Parent/Guardian's Phone 1 *

2nd Parent/Guardian's Full Name

Parent/Guardian's Phone 2

Neighborhood Elementary *

Do you have another
child that attends or
is applying for SSPS? *

Other Children's Name(s)

	Child 1	Child 2	Child 3
Full Name	Child 1	Child 2	Child 3

Other Children's Age(s)

	Child 1	Child 2	Child 3
Age	Child 1	Child 2	Child 3

Class
Session
Preference. *

We would like to keep siblings in the same pod and knowing siblings who are also applying is helpful in this process. This information is how students are placed in classes and it is important that you think about the choice you mark. If there are any reasons your child MUST attend an AM or PM session please explain (below). This information is used in class placements and session changes are not made during the school year or after class placements are completed.

Important Information for the 2022-23 School Year -- At this time, we are in the planning stages of what school options will be offered for the upcoming school year. This information is based on the Public Education Department and the current health orders. In planning for the upcoming school year, please select one of the following that at this time, your family would feel as the best option for your student.

School Options *

I would feel comfortable for my student to attend preschool in a hybrid setting with in person, on campus learning as a component.

I would feel comfortable for my student to attend preschool in a 100% virtual only setting.

Explanation for circumstances requiring a specific class session (optional). *

Class
Session
Preference. *

If there are any reasons your child MUST attend an AM or PM session please explain.
This is considered when placing your child. Session changes are not made during the school year.

Bilingual classrooms at Shining Stars Preschool are intended to provide support in both English and Spanish.

Students will be learning in English, but if they do not understand English, support can be given in Spanish

to ensure student success.

Would you like your child
in a bilingual classroom? *

Primary Home Language *

English

Spanish

Other language(s) spoken: Other language(s) spoken:

Has your child been screened
by Child Find or received special
services in the past or currently? *

If yes, when? * +

Does your child currently
receive speech therapy
services at SSPS? *

Family history of any of the following: Please check those that apply. *

Has there been a
separation or divorce? *

No	Yes (when?) Yes (when?)

Do you or your child receive public financial assistance? Please check those that apply:

Please list all adults in the home:

1. Last Name *

1. First Name *

1. Date of Birth * +

1. Last grade completed *

1. Relationship to the child *

1. Place of work *

2. Last Name

2. First Name

2. Date of Birth +

2. Last grade completed

2. Relationship to the child

2. Place of work

3. Last Name

3. First Name

3. Date of Birth +

3. Last grade completed

3. Relationship to the child

3. Place of work

4. Last Name

4. First Name

4. Date of Birth +

4. Last grade completed

4. Relationship to the child

4. Place of work

Please list all children/siblings (other than child applying):

1. Child's Name

1.Lives
at home?

1. Age

1. Grade

1. Relationship 🛈

2. Child's Name

2.Lives
at home?

2. Age

2. Grade

2. Relationship 🛈

3. Child's Name

3.Lives
at home?

3. Age

3. Grade

3. Relationship 🛈

4. Child's Name

4.Lives
at home?

4. Age

4. Grade

4. Relationship 🛈

Early Development:

Was your
child’s birth: *

Full term

Premature

Late

Has your child
had any chronic
or major
health problems? *

Yes

No

If yes, please list chronic or major health problems: *

Is your
child potty
trained? *

Number of times
childe has moved
since birth. *

Does your
child currently
attend preschool? *

No	Yes (which one?) Yes (which one?)

Please describe your child (interests, likes, dislikes, strengths, etc.) *

My child is bothered by or struggles with: *

Has your child participated in any other programs? (such as private preschool, dance lessons, sports, daycare, etc.) *

I am worried about: *

Is there anything we didn’t ask that you would like to share?

Lottery Application Requirements *

I understand that preschool is a half-day program that meets five days a week: Monday, Tuesday, Wednesday, Thursday, and Friday. I also understand that completing this application does not guarantee my child’s participation in the preschool, and that there will be a lottery to fill the slots for General Education students.

Parent Signature *

clear

Parent/Guardian
Signature Date

form admin
only - test

y

n

Please keep the Application Guidelines page for your information, and submit this application by Friday, April 9, 2023 by 4:00 PM.

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Learning Problems	Abuse	N/A

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