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Madison Metropolitan School District

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MMSD Early Learning Peer Program Application

Required

Child's Namerequired
First Name
Last Name
Date of Birthrequired
Must contain a date in M/D/YYYY format
Genderrequired
EthnicitySelect one or more of the following categories that apply to this student:
Select one or more of the following categories that apply to this student:
Primary Language
Other Languages Spoken in the Home
Parent/Guardian Name(s)required
First Name
Last Name
Parent/Guardian Name(s)
First Name
Last Name
Home Phonerequired
Cell Phone
Work Phone
Email Addressrequired
Addressrequired
Home Schoolrequired

Being an Early Childhood Early Learning Peer provides an opportunity for typically developing children to be integrated into the MMSD Early Childhood Special Education classrooms. Early Learning Peers serve as classmates for MMSD children who require special education services for educational disabilities. Early Learning Peers engage with and model positive peer interactions. Early Learning Peers may also demonstrate age-appropriate play, early learning, behavior, communication, social skills, self-care and motor skills.

1. What is the primary language spoken at home?required
2. Is your child able to speak English in an age appropriate manner?required
3. Is your child toilet trained?required
4. Has your child received any type of services through MMSD or an outside agency?required
4a. If your child has received services, please state what services and when?
5. Has your child ever been identified as having a disability?required
6. Please check the schools you would be willing to attend below:required
7. If your preferred school is not available, would you be interested in attending a different location?required
8. Is your child currently enrolled (or will be in September) in a preschool?required
9. Please describe your child's previous organized group or preschool experiences.required
10. Describe several things that your child is very good at and some areas you feel s/he needs help or encouragement.required
11. What are some of your child's favorite activities?required
12. Does your child have any health concerns?required
12a. If your child does have health concerns, please describe them briefly.

If you have questions, call the PreK Information Line at 608-663-8471.

With respect to educational programs, no person shall be denied admission to any District school, or be denied participation in, be denied the benefits of, or be discriminated against in any curricular, extracurricular, pupil services, recreational or other program or because of the person's sex, race, national origin, ancestry, religion, creed, pregnancy, marital or parental status, sexual orientation, gender identity, gender expression, or disability including her or his physical, mental, emotional, or learning disability.