Dar-us-Salaam

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APPLICANT INFORMATION
Student Name * First Last
Home Phone * ### - ### - ####
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Gender *
Date of Birth * MM / DD / YYYY
PRESCHOOL EXPERIENCE

List preschools, nursery schools, Head Start, special education programs, and other day care programs attended. Include the dates of attendance and the approximate number of hours per week attended.
Name of School
Dates of Attendance
#Hours/Week
Name of School
Dates of Attendance
#Hours/Week
Name of School
Dates of Attendance
#Hours/Week
Why do you feel that your child would be ready for a kindergarten program? Comment on your child's social, behavior and academic skills. *
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