Fillable Family Status Form As a requirement of the

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Family Status Form As a requirement of the

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  • 15 check-boxes
  • 40 other fields

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Family Status Form
Regional Office of Education #08
Early Learning Academy
27 S. State Ave., Suite 101, Freeport, IL 61032
Phone: 815.599.1408 Fax: 815.297.9032
www.roe8.com
Updated November 2020
As a requirement of the Preschool for All program funded by the Illinois State Board of Education, the following
information is requested to be verified by the serving school district upon enrollment in preschool.
Mother’s Name:
Father’s Name:
Employer:
Employer:
Primary Phone Number:
Primary Phone Number:
Legal Guardian?:
Legal Guardian?: YES NO
Marital Status? Single Married
Divorced
Marital Status? Single
Married
Divorced
Highest Level of Education completed by father:
List all people living in the household
Name
Age
How is this person related to child listed above?
Please check the box that best describes your family structure:
Both parents in the home
Single parent family
Lives with an adult other than parent or guardian
Youth in care (DCFS)
Parents have joint custody
I ___________________________________________________________________ verify, that the above information is true and
correct.
_______________________________________ ____________________________
Signature Date
Child’s Name
___________________________
____________ ___________________ ____________________________________________
First Middle Last
_________/
_______ / _________
YES
NO
Highest Level of Education Completed by mother:
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Completed 10 March 2021

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