Pre-K Application 21-22

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Are you looking for a high quality preschool opportunity for your child? Roseburg Public Schools is now accepting applications for the 2021-2022 school year. We encourage all families residing within our district boundaries to apply. To be eligible your child must turn 4 on or before September 1, 2021. Families will receive notification regarding placement on or before June 11th, 2021.

The application will remain open throughout the 21-22 school year. After May 2nd, 2021 applicants will be added to a waitlist, those at the top of the waitlist will be contacted if slots become available.

If you have questions regarding our Pre-K program or application process please contact us:

Roseburg Public Schools District Office Hours: Monday-Friday 8:00 - 4:30
Department of Teaching and Learning: 541-440-4005
Early Learning Facilitator: 541-677-4265 or email: tstedman@roseburg.k12.or.us

Child Information:

(Legal) First Name *

(Legal) Last Name *

Date of Birth *

YYYY

Gender *

Female

Male

Prefer not to say

Other:

Elementary School Attendance Area (select one) *

Phone Number(s) *

Physical Address *

Zip Code *

City *

State *

Previous Classroom Experiences *

Private Pre-K

Head Start

Early childhood special education

Early intervention

None

Other:

Required

Does your family have an Individualized Family Service Plan (IFSP) to support your child’s development? *

Yes

Required

If Yes, please list any health partners you would like us to know about:

Does your child receive any of the following services?

Occupational Therapy

Physical Therapy

Counseling

Home Visiting

Speech

Other:

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