Pre-K Family Application Checklist

Please use this checklist to assist you in making sure your application is complete,

and to facilitate the approval process.  The number of each item corresponds

to each number on the application form.

# 1

Proof of Residence -  Attach a copy of one of the following:

Recent utility bill

Rental lease

Mortgage document

Utility bill

driver's license

Passport

Consulate registration card (Matricula Consular

Rental lease

Mortgage document

Shelter verification form living in a homeless shelter)

# 3

Proof of Child's Age - Attach a copy of one of the following:

Birth certificate

Passport

I-94 Card

Medical Assistance Card

Baptismal certificate

Crib card

Immunization record

# 3

Legal Immigrant - Attach a copy of one of the following:

Medical Assistance card

INS card

# 4

Benefits Family Receives - Attach a signed release form or a copy of one of the following:

Diversionary Work Program (DWP) benefits

Minnesota Family Investment Program (MFIP) benefits

Child Care Assistance Program (CCAP) benefits

# 5

Proof of Earned Income - Attach a copy of one of the following:

Pay Stub

Statement from employer

tax form

w-2 form

# 6

Proof of Child Support - Attach a copy of one of the following:

MFIP/DWP payments letter

Child support letter

Your Preference of Programs - Check one:

Head start

School Based

Licensed home or Center

Page 5

Sign and Date Your Application

Return completed application to:

Minnesota Valley Action Council, 464 Raintree Road, Mankato, MN 56001

If you have any questions, call MVAC at 507 -345-6822