FY2018 Voluntary Pre-kindergarten Supplemental Information

FY2018 Voluntary Pre-kindergarten Supplemental Application Information

To maintain your application for FY2018 Voluntary Pre-kindergarten funds, complete this form by 4:00 p.m. on Saturday July 1, 2017 . Forms will not be accepted after this deadline.

QUESTIONS

Please submit any questions to the Minnesota Department of Education to MDE.VPK@state.mn.us.

1. Program Information

Primary Program Contact for Voluntary Pre-kindergarten

Email Address of Primary Contact *This question is required. This question requires a valid email address.

Phone Number of Primary Contact *This question is required.

School District or Charter School Name:

Please provide your Superintendent/Director's contact information:

Superintendent Name:
Superintendent Email:

2. If using mixed delivery sites, please list all programs you will contract with to deliver voluntary pre-K. (This is not required by statute)

Space Cell	Program Name	Program Contact Name	Program Contact Email
Program #1	Program #1: Program Name	Program #1: Program Contact Name	Program #1: Program Contact Email
Program #2	Program #2: Program Name	Program #2: Program Contact Name	Program #2: Program Contact Email
Program #3	Program #3: Program Name	Program #3: Program Contact Name	Program #3: Program Contact Email
Program #4	Program #4: Program Name	Program #4: Program Contact Name	Program #4: Program Contact Email

3. All programs must submit a Statement of Assurances. The Statement of Assurances must be signed by the Superintendent of your district or Executive Director of your charter school. If you are entering into a mixed-delivery contract, there needs to be a signed Statement of Assurance for each mixed-delivery site signed by the appropriate authority. The statement ensures that your program and any mixed-delivery sites, if applicable, will implement Voluntary Pre-Kindergarten in compliance with the Minnesota Department of Education and under Minnesota Statutes, section 124D.151.

The Statement of Assurances, once signed, must be attached.

Steps to add a Statement of Assurances within the application:
1) Download the Statement of Assurances document here:
2017-18 Voluntary Pre-kindergarten NEW Sites Statement of Assurances
2) Print and sign the document (one signed document per mixed-delivery site, if applicable)
3) Scan the document and save it to your computer
4) Below select Browse to find the document, select it, and wait for it to upload.

File: {{filename}} delete

4. If applicable, indicate any reduction in children that you expect to enroll in your voluntary pre-kindergarten classroom(s) from the number you indicated on your January 2017 application.