Pre-School Scholarship Application Tri-Town Youth Services 56 High Street Deep River, 860-526-3600 Applicants must be CT residents living in the Tri Town Region: Chester, Deep River, or Essex.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Applicant Name *FirstLast DOB *Primary Language *Parent/Gurdian Name *FirstLastStreet Address *Town/Zip Code *FirstLastPhone/Email *FirstLastNames/Ages of other childrenHas your child ever attended preschool? *YesNoIf yes, where and for how long?Do you have transportation to bring your child to and from preschool? *YesNoPreschool Preference: (list top 2 choices) FirstLastYearly Family Income: *0-$25,000$25,000-$35,000$35,000-$45,000$45,000-$55,000$55,000-$65,000Over $65,000Is there any other information you would like the Scholarship Committee to know about your family situation?By signing the space below, you are acknowledging that you have read and agree to the above guidelines and certify that all information provided in the application is accurate. *Parent/Gurdian Signature, DateSubmit