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  • Preschools
  • Types of Programs
  • Interest Form
  • Contact
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Preschool Hub Logo
  • Preschools
  • Types of Programs
  • Interest Form
  • Contact
    • en_USEnglish
    • es_MXEspañol de México
    • arالعربية
    • zh_CN简体中文
    • ukУкраїнська
    • ru_RUРусский
    • swKiswahili
    • viTiếng Việt
Preschool Hub Logo
  • Preschools
  • Types of Programs
  • Interest Form
  • Contact
    • en_USEnglish
    • es_MXEspañol de México
    • arالعربية
    • zh_CN简体中文
    • ukУкраїнська
    • ru_RUРусский
    • swKiswahili
    • viTiếng Việt

Interest Form

Interest Form

Need help choosing a preschool?

Fill out this form to tell us about your family, and we’ll get back to you shortly. If you have any trouble filling out the form, you can call 503-967-1187.

If you already know which preschool you'd like your child to attend, please go to our Directory page to get to the application for that program.

"*" indicates required fields

Parent/Guardian Information

Parent or Guardian Name*
Parent or Guardian Preferred Language*
OK to Text?*
Preferred Contact Method*
Are you willing to provide your address so we know which programs serve your area?*

Child Information

Child Name*
Child Birth Date*
Please note that children need to have been born in 2017, 2018, or 2019 to be eligible for preschool programs beginning fall 2022.
Is this child currently in foster care?*
Is your child a member of a federally recognized tribe?*

Household Information

Household Size:

Please enter a number from 1 to 10.
Please enter a number from 1 to 10.
Is agriculture or farm work (crops, nurseries, tree farms, canneries, dairy, livestock, fish, or bees) the primary source of your family’s income?*
Please check a box or boxes below if your family receives any of the following benefits.
Select the frequency that applies
Could your family be considered housing insecure?*
Are you a single parent?

Optional Information: Needs and Preferences for Preschool

Ideal Schedule

Days of the week needed
Please check all that apply.
Preferred location(s)
Will you be able to transport your child to and from the preschool?
Preferred language(s) for instruction -- check all that apply
*Please note that while instruction is not yet available in all languages, we encourage you to select the ideal format for your child so that we can document the need for additional programming.

Optional Information: Younger Children in the Home

Are there younger children in the home?
When is your due date?
May we contact you about your newborn or infant?
Name of younger child
Younger child birthdate
Name of younger child
Younger child birthdate

Consent / Release of Information:

Are you assisting a parent/guardian with completion of this form, or completing it on their behalf?*
Consent Agreement*
I agree that the information I have provided on this form will be entered into a password-protected database and may be accessed by entities and individuals involved in regional publicly-funded early education programs, including Preschool Promise, Head Start, Early Head Start, Oregon PreKindergarten, tribal programs, and school districts for the purpose of sharing application, eligibility, and enrollment information with me.
By signing below, I attest that I am the custodial parent or legal guardian of the child named above and have the authority to submit this form on their behalf OR that I am assisting with the completion of this form upon direction of the parent/guardian indicated above and that I have obtained verbal consent to do so in their name.
This field is for validation purposes and should be left unchanged.

Questions or need assistance?

Call: (503) 967-1187

Email Us

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